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Authors
Advisor(s)
Abstract(s)
Introdução: O acidente vascular cerebral (AVC) é uma das principais causas de morbilidade
e mortalidade, sendo a segunda causa de morte em Portugal. O AVC é um evento de início
súbito e catastrófico caracterizado por sinais clinicos focais, causados por uma interrupção ou
diminuição do débito sanguíneo no cérebro, com duração superior a 24 horas. Com a
aprovação da terapêutica fibrinolítica nas primeiras 3 horas após instalação de AVC
isquémico, é necessário o acesso expedito destes doentes àquela terapêutica, sendo
fundamental o encaminhamento para uma Unidade de AVC equipada e com equipas
multidisciplinares com experiência, de forma a otimizar os resultados, criando-se assim o
conceito de Via Verde AVC.
Objetivos: Caracterização sociodemográfica e clínica dos doentes com AVC isquémico,
analisar a relação entre a trombólise e os défices resultantes do AVC isquémico e estudar a
relação entre as variáveis sociodemográficas e clínicas na funcionalidade no doente com AVC
isquémico que realiza ou não trombólise.
Metodologia: Estudo comparativo, descritivo-correlacional e analítico, com abordagem
quantitativa. A amostra foi constituída por 203 doentes com AVC isquémico, que estiveram
internados na Unidade de AVC no período compreendido entre 17 de dezembro de 2010 e 10
de julho de 2013, tendo sido ativados como Via Verde AVC no momento de admissão no SU.
Como instrumento foi utilizada uma grelha de recolha de dados que integra a caracterização
sociodemográfica, variáveis clinicas e a escala NIHS.
Resultados: A população estudada era equitativamente distribuída entre homens e mulheres,
com uma média de idades de 73,06 anos, vive maioritariamente em meio rural, provenientes
do domicílio e chega ao hospital transportados de ambulância. Apenas 36,0% da amostra
realizou o tratamento por trombólise, com um tempo médio de 200,08 minutos após a deteção
dos sintomas. Uma vez que é expectável que a trombólise influencie a funcionalidade, optouse
por fazer a análise paralelamente nos grupos de doentes que fizeram e nos que não fizeram
trombólise. Em termos médios, a pontuação da NIHSS na admissão foi de 14,94 e 10,95
pontos nos doentes que fizeram ou não trombólise, respetivamente. No momento da alta
hospitalar, as melhorias são claras, sendo ligeiramente maiores no grupo que fez trombólise,
da ordem dos quatro pontos, enquanto no grupo que não fez trombólise foi somente de um
ponto. Os doentes mais velhos apresentavam pontuação da NIHSS mais elevada em ambos os
momentos. A região cerebral afetada teve consequências variáveis na funcionalidade O tempo
entre o início dos sintomas de AVC e a chegada ao hospital e à realização de trombólise não
teve influência no valor de NIHSS.
Conclusão: Os doentes com AVC isquémico atendidos no CHTMAD no período em estudo
apresentavam os fatores de risco característicos da doença – idade avançada, hipertensão, e
outras doenças concomitantes que contribuem para o desencadear da doença, como a diabetes
e doenças cardiovasculares. A generalidade dos doentes melhorou a sua funcionalidade dos
domínios cognitivo e motor, avaliada pela NIHSS entre a admissão e a alta. Os doentes
tratados por trombólise apresentaram melhorias ligeiramente superiores ao que não tiveram
esse tratamento.
Palavras-chave: Acidente Vascular Cerebral Isquémico, Trombólise, Funcionalidade,
NIHSS.
ABSTRACT Introduction: Stroke is one of the main causes of morbidity and mortality, being the second cause of death in Portugal. Stroke is a sudden onset and catastrophic event characterized by focal clinical signs caused by an interruption or decrease in brain blood flow, lasting for more than 24 hours. With the approval of fibrinolytic therapy in the first 3 hours after the onset of ischemic stroke, it is necessary that these patients have a rapid acces to trombolytic therapy. Routing patients to a specialized stroke unit equipped with experienced multidisciplinary team, is essential in order to optimize the results – the concept of Stroke Green Way (Via Verde AVC, in Portuguese). Objectives: To characterize clinical and sociodemographicaly patients with ischemic stroke, to analyze the relationship between thrombolysis and the deficits resulting from ischemic stroke, and to study the relationship between sociodemographic and clinical variables and the outcome of the patient with ischemic stroke, who does or not thrombolysis. Methodology: A descriptive-correlational and analytical study was designed, with a quantitative approach. The sample consisted of 203 patients who had ischemic stroke who were hospitalized in the Stroke Unit between December 17th , 2010 and July 10th , 2013, and were activated as Via Verde AVC at the moment of admission to the Emergency Department. Data was collected from clinic files, namely on sociodemographic characterization, clinical variables and a NIHS scale. Results: The studied population was equally distributed among men and women, with an average age of 73.06 years old, living mostly in rural areas, arriving at the hospital transported by ambulance mainly from their home. Only 36.0% of the sample made thrombolysis, within an average time of 200.08 minutes after symptom detection. Since thrombolysis is expected to influence the cognitive and motor outcome, we did a parallel analysis on the patients treated with thrombolysis and those who did not. On average, an NIHSS score on admission was 14.94 and 10.95 points for patients treated with thrombolysis and those not treated. At the time of hospital discharge, the improvements were clear, slightly better in the group of thrombolysis, approximately four points, while in the group that did not thrombolysis the difference was around one point. The older patients showed a higher NIHSS score in both moments. We could verify that the affected brain region had variable consequences on functionality and also that the time between the onset of stroke symptoms and hospital arrival and thrombolysis treatment did not influence the NIHSS value. Conclusion: Patients with ischemic stroke attended at the CHTMAD (Hospital Medical Center of Trás-os-Montes e Alto Douro) in the studied period showed the risk factors characteristic of the disease – advanced age, hypertension and other concomitant diseases that contribute to the onset of the disease, such as diabetes and cardiovascular diseases. Most patients improved their functionality of the cognitive and motor domains, evaluated by NIHSS, between admission and discharge. Those treated by thrombolysis showed slightly better improvements than those who did not receive this treatment. Keywords: Stroke, Thrombolysis, Outcome, NIHSS.
ABSTRACT Introduction: Stroke is one of the main causes of morbidity and mortality, being the second cause of death in Portugal. Stroke is a sudden onset and catastrophic event characterized by focal clinical signs caused by an interruption or decrease in brain blood flow, lasting for more than 24 hours. With the approval of fibrinolytic therapy in the first 3 hours after the onset of ischemic stroke, it is necessary that these patients have a rapid acces to trombolytic therapy. Routing patients to a specialized stroke unit equipped with experienced multidisciplinary team, is essential in order to optimize the results – the concept of Stroke Green Way (Via Verde AVC, in Portuguese). Objectives: To characterize clinical and sociodemographicaly patients with ischemic stroke, to analyze the relationship between thrombolysis and the deficits resulting from ischemic stroke, and to study the relationship between sociodemographic and clinical variables and the outcome of the patient with ischemic stroke, who does or not thrombolysis. Methodology: A descriptive-correlational and analytical study was designed, with a quantitative approach. The sample consisted of 203 patients who had ischemic stroke who were hospitalized in the Stroke Unit between December 17th , 2010 and July 10th , 2013, and were activated as Via Verde AVC at the moment of admission to the Emergency Department. Data was collected from clinic files, namely on sociodemographic characterization, clinical variables and a NIHS scale. Results: The studied population was equally distributed among men and women, with an average age of 73.06 years old, living mostly in rural areas, arriving at the hospital transported by ambulance mainly from their home. Only 36.0% of the sample made thrombolysis, within an average time of 200.08 minutes after symptom detection. Since thrombolysis is expected to influence the cognitive and motor outcome, we did a parallel analysis on the patients treated with thrombolysis and those who did not. On average, an NIHSS score on admission was 14.94 and 10.95 points for patients treated with thrombolysis and those not treated. At the time of hospital discharge, the improvements were clear, slightly better in the group of thrombolysis, approximately four points, while in the group that did not thrombolysis the difference was around one point. The older patients showed a higher NIHSS score in both moments. We could verify that the affected brain region had variable consequences on functionality and also that the time between the onset of stroke symptoms and hospital arrival and thrombolysis treatment did not influence the NIHSS value. Conclusion: Patients with ischemic stroke attended at the CHTMAD (Hospital Medical Center of Trás-os-Montes e Alto Douro) in the studied period showed the risk factors characteristic of the disease – advanced age, hypertension and other concomitant diseases that contribute to the onset of the disease, such as diabetes and cardiovascular diseases. Most patients improved their functionality of the cognitive and motor domains, evaluated by NIHSS, between admission and discharge. Those treated by thrombolysis showed slightly better improvements than those who did not receive this treatment. Keywords: Stroke, Thrombolysis, Outcome, NIHSS.
Description
Keywords
Acidente vascular cerebral Factores de risco Isquémia encefálica Reabilitação de acidente vascular cerebral Terapia trombolítica Brain ischemia Risk factors Stroke Stroke rehabilitation Thrombolytic therapy