溶栓药的研究进展

研究出一种既能快速有效溶栓,又不引起出血并发症的新型溶栓药一直是各国研究者的目标。本文对目前溶栓药的优缺点进行综述,为以后的溶栓药研究提供参考。     

急性脑梗死超早期溶栓护理进展

急性脑梗死（AICD）超早期溶栓治疗是目前国内外急性脑梗死治疗的研究热点。已知用于临床治疗的溶栓药物有链激酶（SK）、尿激酶（UK）和基因重组组织纤溶酶原激活剂（r—tPA）。给药途径包括静脉滴注和局部动脉内灌注溶栓（LIF）。用药时间在6h以内。由于溶栓药物在AICD超早期溶栓应用可能带来严重出血的潜在危险，所以，此项治疗仍处于探索阶段，     

超声波辅助溶栓药治疗脑梗塞59例对照研究

目的探讨超声波辅助溶栓药治疗脑梗塞的临床疗效。方法总共入选病人116例,分为单纯溶栓药物治疗组(57人)和联合超声治疗组(59人),治疗36天。结果联合超声波治疗脑梗塞,基本治愈18.6%,显效40.7%,进步37.3%,无效3.4%,总有效率96.6%,与单纯溶栓治疗组比较,疗效明显(P<0.01)。结论超声波辅助溶栓治疗脑梗塞,可以显著改善病人临床症状,疗效满意。     

80岁以上高龄老人急性心肌梗死溶栓治疗的临床探讨

目的探讨80岁以上高龄老人ST段抬高的急性心肌梗死(AMI)静脉溶栓治疗的疗效和安全性.方法使用尿激酶(UK)静脉溶栓治疗80岁以上的AMI患者9例.观察疗效及随访资料.结果间接指标表明9例80岁以上的高龄老人AMI静脉溶栓成功,梗死相关血管(IRA)再通.结论 80岁以上的高龄老人AMI在无绝对禁忌证时,采用个体化给药进行静脉溶栓是相对安全、有效的.     

尿激酶不同给药方法治疗动静脉内瘘血栓的疗效观察

目的：观察尿激酶两种不同的给药方法治疗血液透析患者自体动静脉内瘘血栓溶栓的疗效。方法选取我院2010年10月-2013年10月自体动静脉内瘘血栓形成患者26例,随机分为两组。 A组：连续性微泵注射溶栓组;B组：间断静脉注射溶栓组。结果比较两组溶栓的效果A组溶通11例,占84.6%;B组溶通8例,占61.5%。连续性微泵注射溶栓治疗效果优于间断静脉注射组。组间比较差异有统计学意义P＜0.05。结论尿激酶持续微泵注射溶栓作用持久,其疗效与血栓栓塞时间密切相关,早期溶栓效果显著。     

急性心肌梗死并发室颤溶栓治疗的监护体会

目的总结静脉溶栓治疗急性心肌梗死(AMI)并室颤患者的护理体会。方法应用尿激酶经静脉给药进行溶栓治疗,针对AMI并室颤患者抢救过程中出现的护理问题采取积极有效的护理措施,提高抢救成功率。     

超声波辅助溶栓药治疗脑梗塞59例对照研究

目的 探讨超声波辅助溶栓药治疗脑梗塞的临床疗效。方法总共入选病人116例,分为单纯溶栓药物治疗组（57人）和联合超声治疗组（59人）,治疗36天。结果联合超声波治疗脑梗塞,基本治愈18．6％,显效40．7％,进步37．3％,无效3．4％,总有效率96．6％,与单纯溶栓治疗组比较,疗效明显（P〈0．01）。结论超声波辅助溶栓治疗脑梗塞,可以显著改善病人临床症状．疗效满意。     

急性心肌梗死药物溶栓治疗的新进展

急性心肌梗死(AMI)属于严重的心血管事件,发病急,死亡率高,且发病率逐年增高,是目前急救医学中最常见的危重症。其死亡率的高低和缺血心肌改善与早期再灌注治疗密切相关。急诊经皮冠状动脉介入治疗(PCI)在目前急性心肌梗死患者的血管重建上有着显著优势,但基层医院因受各种因素影响,开展PCI比较困难,所以药物溶栓治疗仍然是当下基层医院治疗心肌梗死的重要措施。溶栓药物包括尿激酶,重组织型纤溶酶原激活剂(rt-PA),瑞替普酶等。近年来的研究发现,瑞替普酶作为第三代溶栓药物是一种新型的非糖基化纤溶酶原激活物,具有很强的纤维蛋白选择性。与其他溶栓药相比,瑞替普酶具有给药方便,易于掌握,血管开通时间提前,能尽早和更大限度地挽救濒死心肌等优点。     

浅谈急性心肌梗死的早期静脉溶栓治疗观察

急性心肌梗死是冠状动脉突然发生阻塞．局部心肌由于血供中断而发生缺血坏死。静脉溶栓疗法能使急性心肌梗死的预后完全改观．而且给药方便,已成为急性心肌梗死治疗中最重要的方法之一。     

80岁以上高龄老人急性心肌梗死溶栓治疗的临床探讨

目的 探讨80岁以上高龄老人ST段抬高的急性心肌梗死(AMI)静脉溶栓治疗的疗效和安全性。方法 使用尿激酶(UK)静脉溶栓治疗80岁以上的AMI患9例。观察疗效及随访资料。结果 间接指标表明9例80岁以上的高龄老人AMI静脉溶栓成功，梗死相关血管(IRA)再通。结论 80岁以上的高龄老人AMI在无绝对禁忌证时，采用个体化给药进行静脉溶栓是相对安全、有效的。     

缺血性卒中溶栓治疗的研究进展

研究表明溶栓治疗是有效和安全的,但溶栓药物的选择与剂量、溶栓治疗时间窗、适应证、溶栓途径、合并用药的利弊、溶栓后并发症等问题仍是面前研究的热点,本研究对此方面的研究现状及进展进行综述。     

生物源毒素在临床医学中的应用及前景

对生物源毒素的临床治疗药物价值及作为药物应用的情况、今后的发展前景作了介绍和分析。神经系统的治疗药物有用于若干局部强力障碍治疗的甲型肉毒毒素，阻断神经传导止痛的河豚毒素、石房蛤毒素、青环海蛇毒素等。心血管系统的治疗药物有用于治疗脑血栓、冠状动脉血栓的蝮蛇精氨酸酯酶，提高心肌兴奋作用的西加毒素，升高血压的岩沙海葵毒素，降血压的石房蛤毒素，抗肿瘤药物的免疫毒素等     

Patients with lung emboli and hemodynamic stability: insufficient evidence for routine thrombolysis

Pulmonary embolism (PE) is a common disorder requiring prompt anticoagulant treatment. As spiral CT has become the first-line test for PE diagnosis, physicians will likely be increasingly confronted with patients displaying large centrally located pulmonary emboli. Evidence from literature supporting the use ofthrombolytic drugs in patients with PE is sparse, since only one small trial has demonstrated that these drugs can reduce short-term mortality in patients with emboli and shock. Patients with PE can present without massive arterial hypotension but with signs of right ventricular dysfunction on echocardiography or CT. One recent randomised trial evaluated whether these haemodynamically stable patients would benefit from thrombolytic therapy. However, no definitive conclusions can be drawn from this study. Potentially, other prognostic markers including brain type natriuretic peptide may be better predictors of suitable candidates for thrombolytic therapy. It is concluded that based on current knowledge, patients with PE who presentwithout arterial hypotension should not routinely be treated with thrombolytic drugs, irrespective of whether they display central emboli on CT or not.     

Clinical management where medicine meets management. All of a rush

The time between a myocardial infarction patient arriving at hospital and receiving life-saving drugs is decreasing. Schemes to speed up care include paramedics administering thrombolytic drugs. Hospitals are also finding ways of speeding up admission patients.     

甘肃地区缺血性脑卒中患者卒中认知调查及影响因素分析

目的调查缺血性卒中患者对卒中危险因素、预警症状及溶栓治疗认知情况,并探索影响卒中认知的相关因素。方法自2015年3月至2015年9月期间,使用结构式问卷横断面调查缺血性卒中患者对卒中的认知,分析卒中认知与可能影响卒中认知的相关因素,采用单因素及多因素回归分析探索影响缺血性卒中患者卒中认知的因素。结果共调查了138例就诊于兰州大学第一医院神经内科的缺血性卒中患者,年龄(63.53±11.41)岁,男性89例(60.1%)。认知率最高的卒中危险因素是高血压(64.5%),卒中症状是偏侧肢体无力(60.1%);知道溶栓治疗5.8%,知道溶栓治疗时间窗为1.4%。单因素回归分析显示文化程度与识别3个及以上卒中危险因素(P=0.036)和卒中症状(P=0.042)、知道溶栓治疗(P=0.045)及时间窗(P=0.017)都有关。多因素回归分析显示发病时能识别卒中症状(OR=0.252,P=0.012)是识别3个及以上卒中危险因素的独立预测因素;使用非正规降压药物(OR=1.344,P=0.024)和发病后急诊转运途径(OR=0.662,P=0.05)是识别3个及以上卒中症状的独立预测因素;发病时能识别卒中症状(OR=2 249.238,P=0.032)是知道卒中溶栓治疗的独立预测因素。结论急性缺血性脑卒中患者对卒中危险因素、症状及溶栓治疗的认知率低,更高的文化程度和卒中高认知率有关。     

Thrombolysis for myocardial infarction

Treating myocardial infarction by dissolving occlusive thrombi in coronary arteries is an attractive idea. Although some thrombolytic agents have been available for many years their use in this role has only recently been critically examined. The place of thrombolysis in the management of myocardial infarction has yet to be determined.     

A cluster randomised trial to assess the impact of clinical pathways on AMI management in rural Australian emergency departments

Background

People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs. The purpose of this study is to determine the impact of a five-step clinical pathways implementation process on the timely and efficient administration of thrombolytic drugs for acute myocardial infarctions managed in rural Australian emergency departments.

Methods/Design

The design is a two-arm, cluster-randomised trial with rural hospital emergency departments that treat and do not routinely transfer acute myocardial infarction patients. Six rural hospitals in the state of Victoria will participate, with three in the intervention group and three in the control group. Intervention hospitals will participate in a five-step clinical pathway implementation process: engagement of clinicians, pathway development according to local resources and systems, reminders, education, and audit and feedback. Hospitals in the control group will each receive a hard copy of Australian national guidelines for chest pain and acute myocardial infarction management. Each group will include 90 cases to give a power of 80% at 5% significance level for the two primary outcome measures: proportion of those eligible for thrombolysis receiving the drug and time to delivery of thrombolytic drug.

Discussion

Improved compliance with thrombolytic guidelines via clinical pathways will increase acute myocardial infarction survival rates in rural hospitals and thereby help to reduce rural-urban mortality inequalities. Such knowledge translation has the potential to be adapted for a range of clinical problems in a wide array of settings.

Trial registration

Australia New Zealand Clinical Trials Registry code ACTRN12608000209392.     

Thrombolytic therapy of brain infarct: the end of beginning

Thrombolysis by intravenous application of thrombolytic drugs may improve the outcome of patients with a brain infarct, but it also entails risks. The effect of recombinant tissue plasminogen activator (rtPA) was compared with placebo in three medium-sized randomized controlled clinical trials. One study, performed in North America, showed a clear benefit of rtPA administered within 3 hours after the onset of symptoms. Two European trials showed a less strong effect, but the number of patients who were independent after 3 months' follow-up was also larger after treatment with rtPA within 6 hours. A meta-analysis of all three trials demonstrates a significant advantage of rtPA over placebo for all the usual outcome measures, without significant excess mortality in the rtPA group. The chance of being able to live independently increases by about 8% after treatment with rtPA. In conclusion there is now sufficient evidence to start with thrombolytic treatment for cerebral infarcts in hospitals with a stroke unit, if a number of additional quality standards for the acute diagnosis and treatment of stroke patients are met.     

早期积极溶栓治疗急性心肌梗死83例疗效观察

目的 探讨早期积极溶栓治疗急性心肌梗死的临床疗效.方法 选择笔者所在医院2005年6月至2009年6月收治的83例急性心肌梗死患者,根据以上患者溶栓治疗时间分为观察组和对照组,观察组实施早期溶栓（发病到溶栓治疗时间小于4 h）治疗,对照组实施非早期（从发病到溶栓治疗时间在4～12 h内）溶栓治疗.结果 观察组心绞痛发生率、心力衰竭发生率与对照组比较,差异有统计学意义（P〈0.05）.结论 早期溶栓治疗可以显著降低急性心肌梗死患者心绞痛和心力衰竭发生率,临床治疗效果显著,值得借鉴.