国际循环：美国AHA/ASA的一项新建议为组织型纤溶酶原激活剂（tPA）在严格筛选的急性缺血卒中症状出现3~4.5小时内的应用开了绿灯。tPA治疗时间窗的延长对缺血性卒中患者和医生来说有怎样的影响？
Jauch教授：这对于转运时间长或到达医院接近3小时的患者有重要的影响，又给了医生30～60分钟的时间，使那些本来不符合静脉tPA治疗的患者可以考虑使用tPA治疗。我同时认为，这也为那些因没有神经科医生或没有CT的医院将患者转院至卒中中心提供了时间。
International Circulation: A new science advisory from the AHA/ ASA has given the green light for the use of tissue plasminogen activator (tPA) to treat acute ischemic strokes between 3 and 4.5 hours after symptom onset. What kind of impact will the extended time window have for ischemic stroke patients and doctors?
国际循环：美国AHA/ASA的一项新建议为组织型纤溶酶原激活剂（tPA）在严格筛选的急性缺血卒中症状出现3~4.5小时内的应用开了绿灯。tPA治疗时间窗的延长对缺血性卒中患者和医生来说有怎样的影响？
Prof. Jaunch: This is going to have a significant impact for many patients who because of long transport times and who arrive very close to three hours， by the giving the doctors and extra 30~60 minutes will make many patients who would not have been eligible now eligible for that. I also think it will give patients who go to hospitals that can not give tPA because they do not have neurologists or they do not have CT scanners who will now be able to be transferred to hospitals that are stroke centers. This extra time will enable them to be transferred and have a diagnosis made. I think many people have not been treated because they are beyond the window of time and I also think that many hospitals have decided to not treat stroke because do not think they can do it fast enough， but now that the window is longer I think that many hospitals will reconsider giving tPA and reconsider building an infrastructure because now they have more time to do it. I am hopeful that it will renew interest in stroke and give many people who have just missed the 3 hour window an opportunity for treatment.
Jauch教授：这对于转运时间长或到达医院接近3小时的患者有重要的影响，又给了医生30～60分钟的时间，使那些本来不符合静脉tPA治疗的患者可以考虑使用tPA治疗。我同时认为，这也为那些因没有神经科医生或没有CT的医院将患者转院至卒中中心提供了时间。新增加的时间使他们可以转院并完成诊断、制定可能的治疗方案。我认为很多患者是因为错过了治疗的时间窗而没有进行tPA治疗，同时我还认为许多医院决定不对卒中患者进行治疗是因为他们认为自己治疗的速度不够快，但是现在治疗的时间窗延长了，我想很多医院会重新考虑进行tPA或支架治疗，因为现在有足够的时间了。我希望这个建议可以改变人们对卒中的认识，给许多超过3小时时间窗的患者一个治疗的机会。
International Circulation: Intravenous rt-PA is the only drug proven to be effective in ischemic stroke but only a small proportion of ischemic stroke patients end up getting intravenous rt-PA thrombolytic therapy. What are the main reasons for this and how can we optimize the number of potential candidates for thrombolytic therapy?
国际循环：静脉应用制剂重组组织型纤溶酶原激活剂（rt-PA）是缺血性卒中唯一被证实有效的溶栓药物，但是只有小部分卒中患者接受了静脉rt-PA溶栓治疗。出现这种现象的主要原因是什么？我们怎样才能优化潜在可以接受溶栓治疗患者的数量？
Prof. Jaunch: The number one reason in most countries is that patients do not get to the hospital within 4.5 hours. The hardest thing is to get patients to recognize stroke， call the ambulance， and get to the hospital on time. That has been the biggest limitation. The second limitation is that not all hospitals treat stroke in the USA or in many other countries. There are hospitals that are committed and dedicated to treating stroke and others that can’t do it. Therefore， we have to get patients in quickly in tell the ambulances which hospitals to take the patients to. If we can fix those two problems we will make many more patients eligible for thrombolytics.
Jauch教授：大多数国家出现这种现象的一个原因是患者多不能在4.5小时内到达医院。最困难的事情是使患者认识卒中、呼叫急救车和及时到达医院。这就是最大的局限性；第二个原因是在美国或其它国家不是所有的医院都能治疗卒中，有一些医院是指定及专门治疗卒中的而有些医院不能治疗卒中。因此，我们需要将患者立即转运，并告诉救护车司机患者应该去哪家医院。如果我们可以解决这两个问题，就可以使更多的患者接受溶栓治疗，改善患者的预后。
International Circulation: How should the rapid evaluation of ischemic stroke patients be facilitated? In the emergency department， how can it be determined whether a patient is appropriate for reperfusion therapy?
国际循环：应该怎样易化缺血性卒中患者的快速评价手段？在急诊室，怎样确定一个患者是否适合再灌注治疗？
Prof. Jaunch: The first thing is to confidently establish the diagnosis. You certainly need a CAT scan and a good neurologic exam to establish that the patient’s symptoms are due to an ischemic stroke. Once you have established the diagnosis， then you must be knowledgeable and understanding of the inclusion/exclusion criteria for tPA. Lastly， I think you must have a team because a lot must happen very quickly. You can have one doctor working with the patient and doing the exam and another one determining eligibility， looking at their medical records， evaluating their CAT scan， looking at their laboratory values， and talking to the patient’s family. By having a team approach you can optimize how quickly a patient can get through the system. Asking one doctor to do everything is asking too much when they only have minutes to make a decision.
Jauch教授：首先要做的是明确诊断。你需要进行CAT扫描及彻底的神经系统查体来确定患者的症状是否由缺血性卒中引起。一旦确定诊断，你必须充分掌握rt-PA应用的适应证和禁忌证。最后，我认为你应该有一个治疗梯队，因为有许多突发事件必须迅速处理。你可以让一位医生对患者进行查体和检查，另一位医生评价患者溶栓指征、查阅病历、评价CAT扫描、查看实验室检查结果以及与患者家属谈话。如果有一个卒中的梯队你就可以优化这些过程使患者快速的通过评估。当需要一名医生在有限的时间内制定出患者的治疗方案时，所有的事情都让他一个人做就会有点多。
International Circulation: How are telemedicine systems utilized in the stroke systems in your country? How do you see the future of telemedicine in the stroke care delivery system?
国际循环：在您的国家是怎样将远程医疗系统用于卒中系统疾病的？您认为远程医疗系统中的中风护理投药系统的前景如何？
Prof. Jaunch: That is a great question. We recently published two papers on telemedicine in Stroke. I think the papers reflect an enthusiasm and excitement for telemedicine. In my own personal hospital we have seven telemedicine hospitals that we communicate with and we find that the patients are very happy with this， the doctors at these outside hospitals that do not have neurologists are happy with having expertise， and we have found that we have been able to deliver advice and tPA very effectively and safely using telemedicine. You will definitely see much more telemedicine in the USA in the near future. We have to overcome issues of payment， licensing， and availability of neurologists， but you are going to
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