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急性缺血性卒中是一种发病率、致死率、致残率、复发率均较高的脑血管疾病,严重危害患者的健康。溶栓药物通过激活纤维蛋白溶酶原(简称“纤溶酶原”),来快速溶解血栓,减少血小板聚集,实现血管成功再通,对急性缺血性卒中的治疗具有关键作用。本研究基于当前国内外研究,从溶栓药物的作用原理及分类运用等方面进行综述。结果发现,从不具有纤维蛋白特异性的第一代溶栓药物链激酶,到第三代溶栓药物替奈普酶,第三代溶栓药物既保留了直接活化纤溶酶原的特性,还增强了纤维蛋白特异性,延长了半衰期,有效性和安全性更好。随着研究的发展,具有纤溶酶原激活物抑制作用的小分子化合物,或者改造具有较强体内抗纤溶酶原激活物抑制活性的溶栓药物,或者从微生物、天然植物中寻找新型的具有溶栓作用的小分子物质,成为了新型溶栓药物研究的热点。新型溶栓药物可能因具有更强的溶栓效率和更少的副作用,而成为当前溶栓治疗的替代药物。 相似文献
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rt—PA静脉溶栓治疗38例脑梗死的护理 总被引:3,自引:1,他引:2
目的观察重组组织纤溶酶原激活剂(rt—PA)静脉溶栓治疗超早期脑梗死的疗效、安全性及rt-PA静脉溶栓治疗后护理体会。方法对符合入选条件的患者进行rt-PA静脉溶栓治疗,将总剂量的10%,缓慢静脉推注,持续1rain,将剩余的90%加入生理盐水,以输液泵静脉点滴,持续1h,记录输注开始及结束时间,溶栓后24h口服肠溶阿司匹林100~300mg/d,10d,维持量100mg(继发脑或全身大出血者停用)。轻度皮肤粘膜及胃出血,出血停止1周后继续给予维持量。不能耐受阿司匹林者,口服氯吡格雷75mg/d。结果溶栓后有3例发颅内出血,其余35例均达到溶栓效果。结论如果严格掌握时间窗及适应证,掌握护理要点,应用rt-PA静脉溶栓治疗超早期脑梗死安全、有效,治疗时间越早,疗效越显著。 相似文献
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对13例发病6小时以内的AMI患者应用rt-PA静脉溶栓治疗。在180分钟内给药总量为100mg,根据床旁指标判定10例再通,开通率达76.9%,仅1例出现牙龈出血。在溶栓2小时内发现心律失常10例,死亡1例。本文就rt-PA的特点及静脉溶栓时机,再灌注心律失常进行讨论。 相似文献
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自16年前首次被证明静脉溶栓可有效治疗急性缺血性卒中以来,溶栓率一直不高。尽管很多试验证明了许多溶栓药物的疗效,但静脉注射用组织型纤溶酶原激活剂(rt-PA,0.9 mg.kg-1)几乎成为惟一用于溶栓治疗的溶栓剂。针对这种情况,研究者正在多方面对研究工作进行改进,包括使用新的溶栓药物。另外,研究者正在尝试用新的溶栓剂、低剂量的rt-PA、神经保护剂等减少症状性脑出血的危险。 相似文献
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目的 分析2005-2009年期间本院应用重组组织型纤溶酶原激活剂( rt-PA)和尿激酶(UK)静脉溶栓治疗患者的院内死亡发生情况。方法 对应用rt-PA或UK溶栓治疗的ST段抬高的急性心肌梗死患者(n=57)和肺血栓栓塞症患者(n=60)的溶栓剂应用情况、死亡原因等进行回顾分析研究。 结果 117例接受溶栓治疗的患者院内死亡10例(8.5%),原因为心源性休克(6例)、心脏破裂(3例)和心室颤动(1例)。10例死亡患者中,无1例因出血并发症死亡;7例为ST段抬高的急性心肌梗死患者,肺血栓栓塞症患者因心源性休克死亡3例。应用rt-PA溶栓治疗的98例(84%)患者院内死亡7例,19例患者接受UK溶栓治疗,死亡3例。结论 溶栓治疗患者的院内死因主要与基础疾病相关,科学规范的应用溶栓治疗是安全的。 相似文献
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重组人组织型纤溶酶原激活剂及其突变体的溶血栓研究 总被引:1,自引:0,他引:1
目的 比较重组人组织型纤溶酶原激活剂(rht-PA)及其突变体FsGGI和FrGGI的溶血栓作用,验证突变体的构建思想。方法 采用兔颈静脉溶栓模型和体外溶栓试验对纯化的rht-PA及其突变体FsGGI和FrGGI进行家兔体内外溶栓研究。结果 rht-PA、FsGGI及FrGGI三者均有体内外溶栓作用,体外溶栓能力基本相似;体内溶栓活力突变体FsGGI与FrGGI类似,均显著高于rht-PA,溶栓度分别为20.1%、49.1%和46.6%。在体内溶栓作用的同时均未引起血浆纤维蛋白原滴度下降。结论 溶栓作用是血栓特异性的,两种突变体是优于野生型t-PA的溶栓剂,上游的构建思想是正确的。 相似文献
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目的:观察动静脉内瘘闭塞后尿激酶(UK)溶栓治疗效果,探讨影响溶栓效果的主要因素及护理方法。方法选择2010年12月至2013年12月因动静脉内瘘闭塞住院的20例患者,采用UK溶栓治疗,辅以溶栓后护理,分析闭塞的动静脉内瘘溶栓后再通率及影响因素。结果20例动静脉内瘘闭塞患者中,14例再通,6例无效,复通率为70%。再通患者闭塞时间均在12 h以内,血栓形成长度小于30 mm。结论动静脉内瘘闭塞后溶栓治疗时间越早、血栓形成长度越短,治疗效果越好。溶栓治疗后辅以正确的护理更有助于患者血管再通。 相似文献
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溶栓治疗急性心肌梗死(AMI)已广泛应用于临床,目前国内常用溶栓药物尿激酶(UK)、链激酶(SK)及重组组织型纤溶酶原激活剂(rt-PA)为溶栓剂。笔者采用新型溶栓药物瑞替普酶(派通欣)治疗,取得较好疗效,现将资料完整的3例报告如下。 相似文献
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梁峰 《中国医院用药评价与分析》2003,3(1):21-25
目的 :介绍急性心肌梗死溶栓药物的研发进展 ,并评价其临床疗效和安全性。方法 :通过查阅国内、外有关急性心肌梗死溶栓药物的文献进行评述。结果与结论 :溶栓仍是急性心肌梗死的主要治疗措施。至于何种溶栓剂疗效更好 ,仍需进一步的研究证明 ;虽然近年来人们开发和研制出各种新型溶栓剂 ,但溶栓治疗的血管再通率仍低 ,故还应寻找联合其他治疗措施的溶栓方案。 相似文献
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溶栓治疗是改善急性缺血性脑卒中患者临床预后的有效治疗方法 ,但同时有再灌注损伤、症状性颅内出血、血管再闭塞等并发症,且起病至溶栓治疗时间、神经功能缺损程度、患者年龄、溶栓药物剂量、高血压、糖尿病、抗血小板药物等因素均可能增加溶栓并发症的发生及影响临床预后,在临床应用时应充分考虑影响预后的各种因素,以此指导溶栓治疗。现将临床常见影响溶栓治疗预后的因素进行综述。 相似文献
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Fred L. Meister Pharm.D. Kathleen A. Stringer Pharm.D. Sarah A. Spinler Pharm.D. Edgar Gonzalez Pharm.D. Robert L. Talbert Pharm.D. Bruce Weiner M.S. FASHP Rawley M. Guerrero Pharm.D. Richard Smith Pharm.D. 《Pharmacotherapy》1998,18(4):686-698
Numerous factors must be considered when determining the formulary status of thrombolytic agents for the treatment of acute myocardial infarction. Defined treatment options, predicted outcomes, and the economic consequences of this disorder continue to evolve from clinical trials. Pharmacists have a major role in delivering patient care, with responsibility for evaluating, procuring, and monitoring thrombolytic agents and drug therapy in general. By participating in the development and implementation of treatment guidelines, evaluating economic and therapeutic outcomes, providing timely optimal drug therapy, and educating health care providers and the public, they contribute significantly to the health care team. 相似文献
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Vaidya B Nayak MK Dash D Agrawal GP Vyas SP 《International journal of pharmaceutics》2011,403(1-2):254-261
In recent times, search for potent and highly selective thrombolytic agents with minimal side effects has become a major area of research. The aim of the present study was to develop and characterize target sensitive (TS) liposomes encapsulating streptokinase, a thrombolytic agent. The developed TS liposomes were composed of dioleylphophatidyl ethanolamine (DOPE) and dipalmityl-c(RGDfK) (10:1mol/mol). Dipalmityl-c(RGDfK) was synthesized using typical carbodiimide chemistry using palmitic acid and c(RGDfK), while lysine was used as a spacer. Liposomes were of 100-120nm size. In vitro drug release study showed that nearly 40% drug of the entrapped drug was released in 12h in the PBS (pH 7.4), however on incubation with activated platelet about 90% of drug was released within 45min. The results suggested target sensitivity of the liposomes. Further, targeting potential was confirmed using fluorescent microscopy and flow cytometry. Clot lysis study revealed that TS liposomes could not only reduce the clot lysis time but also increase the extent of clot lysis as compared to non-liposomal streptokinase solution. In conclusion, the present liposomal formulation will target the thrombolytic agent to the activated platelets in the thrombus and hence will improve the therapeutic efficacy of the drug. 相似文献
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溶血栓药物在急性脑梗死中的应用进展 总被引:1,自引:0,他引:1
脑梗死是导致人类致残和死亡的主要疾病之一,在发生脑梗死的超急性期,积极给予溶栓治疗,开通闭塞的血管,恢复缺血区的再灌注是治疗的关键。目前只有重组组织型纤溶酶原激活剂(rt-PA)被FDA批准应用于急性脑梗死的溶栓治疗,其他的许多药物如瑞替普酶,替奈普酶,去氨普酶、安克洛酶等在脑梗死治疗应用方面正在探索中。本文将针对上述几种主要的溶血栓药物及其已经开展的相关临床研究进行论述。 相似文献
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This study looked at outcomes of acute myocardial infarction patients following administration of streptokinase or alteplase. For 150 patients (155 thrombolytic drug administrations), the median time delay between onset of symptoms and thrombolytic therapy was 3.6 hours. Only 65 per cent of streptokinase-treated patients tolerated the recommended dose, compared with 85 per cent of those treated with alteplase. Aspirin usage was uncommon (9 per cent) prior to admission but rose to 68 per cent on discharge. However, β-blocker usage only increased from 16 per cent to 24 per cent. Parenteral and oral anticoagulant usage was numerically greater in the alteplase group. There was no significant difference between streptokinase or alteplase in the incidence of any observed adverse effects. There were no allergic type reactions in the alteplase group. The incidence of such reactions in the streptokinase group was not affected by pre-treatment with anti-allergy drugs. Patients in both thrombolytic drug groups experienced similar falls in blood pressure but severe hypotension was more common in the streptokinase group. 相似文献
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《Eksperimental'naia i klinicheskaia farmakologiia》2005,68(1):71-73
The results of experiments on rabbits showed that the new drug piyavit, possessing pronounced thrombolytic properties, readily diffuses through cornea to the anterior chamber of eye. It is suggested that the biologically active components of piyavot facilitate the drug penetration through the corneal barrier. This favors maximum drug concentration and positively influences the therapy of traumas and eye diseases accompanied by hemorrhages. 相似文献
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Madden K 《CNS drugs》2002,16(4):213-218
The clinical benefit of thrombolytic therapy for patients experiencing acute cerebral ischaemia has been demonstrated by both clinical trials and phase IV studies. However, such treatments must be initiated in a rapid manner, with treating physicians adhering to strict protocols designed to minimise delays and maximise safety. The efficacy of intravenous drug administration has been established with alteplase (recombinant tissue plasminogen activator; tPA) and ancrod, but only if these drugs can be administered within 3 hours of symptom onset. The use of alteplase beyond this timeframe, or outside of established protocols, may be hazardous. The use of alternative intravenous thrombolytic agents, such as streptokinase, also appears hazardous. Intra-arterial delivery of thrombolytic drugs such as pro-urokinase may extend clinical benefit to the 6-hour time frame. 相似文献