重组人组织型纤溶酶原激活剂缺失变体对犬冠状动脉血栓的溶栓作用

目的观察重组人组织型纤溶酶原激活剂缺失变体(reteplase)对犬冠状动脉血栓的溶栓作用。方法实验用杂种犬,设溶剂对照组r、eteplase 100×104、50×104和25×104IU/kg 4组。手术分离冠状动脉左旋支(LCX),以血管内膜粗糙 电刺激法形成冠状动脉左旋支血栓,检测静脉注射不同剂量reteplase后对冠状动脉左旋支血流量、栓塞再通率、心肌梗死范围、伤口失血量和末梢出血时间的影响。结果静脉注射reteplase可使栓塞的冠状动脉血管很快出现再通,血流量显著增加,心肌梗塞范围明显缩小,明显增加伤口出血量,延长末梢出血时间,rete-plase各剂量组与溶剂对照组比较均有显著差别(P<0.001)。结论reteplase对犬冠状动脉血栓具有显著的溶栓作用。     

急性心肌梗死溶栓后检测肌红蛋白、肌钙蛋白I、肌酸激酶同工酶对冠脉再通的诊断价值

目的探讨血清肌红蛋白(Mb)、肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)对急性心肌梗死溶栓冠脉再通的早期诊断价值。方法应用酶联免疫分析法测定106例急性心肌梗死患者溶栓治疗后Mb、cTnI、CK-MB浓度的变化,分析急性心肌梗死患者溶栓再通组(73例)和溶栓未通组(33例)上述指标的变化。结果急性心肌梗死溶栓再通组Mb、cTnI和CK-MB达到峰值浓度的时间较未通组明显提前(P<0.05),其中Mb较cTnI、CK-MB峰值出现更早,分别为(5.9±2.5)h、(14.5±3.2)h和(14.8±3.9)h(P<0.01);Mb、cTnI和CK-MB对判断冠脉再通的敏感性、特异性、预测值无显著性差异(P>0.05)。结论血清Mb、cTnI和CK-MB可以较好地预测急性心肌梗死患者溶栓再通,其中Mb较cTnI、CK-MB能更早的判定冠状动脉是否再灌注。     

Temporary Vena Cava Filters and Ultrahigh Streptokinase Thrombolysis Therapy: A Clinical Study

Purpose: To assess the efficacy of temporary vena cava filters in patients undergoing ultrahigh-dose streptokinase thrombolysis for iliocaval thrombosis and to determine therapy success and filter and therapy complications. Methods: Forty-five patients were studied regarding extension and characteristics of thrombosis, duration, success, and complications of thrombolysis therapy, filter type, access route, pulmonary embolisms, and filter complications. Results: Complete recanalization was achieved in 57% of cases. Filters were inserted predominantly via a transbrachial route. One fatal pulmonary embolism (2%) occurred 1 day after starting thrombolysis. No other pulmonary embolism was noted. Other complications were induced by thrombolysis alone (n = 12), thrombolysis and filter (n = 9), and filter alone (n = 11). Conclusion: Fatal pulmonary embolisms as a complication of ultrahigh-dose treatment of pelvic or caval thrombosis can not safely be prevented by the temporary vena cava filters currently available. Filter design needs to be improved.     

急性心肌梗死合并2型糖尿病优化介入治疗与直接经皮冠状动脉介入治疗的临床对比研究

目的 探讨经皮冠状动脉介入治疗（PCI）联合尿激酶静脉溶栓（即优化介入治疗）与直接经皮冠状动脉介入术治疗急性心肌梗死（AMI）合并2型糖尿病（DM）的有效性和安全性。方法 78例发病时间≤12h的首次AMI患者随机分为溶栓治疗＋PCI组（45例）和直接PCI组（33例），对2组患者介入治疗前梗死相关血管（IRA）通畅率、介入治疗成功率、出血并发症发生率、住院期间急性心脏缺血事件发生率及出院前左心室功能（LVEF）进行比较。结果 冠状动脉介入治疗前溶栓治疗＋PCI组IRA通畅率（53．3％）显著高于直接PCI组（24．3％）（P〈0．05），前者介入治疗成功率98．0％；2组开通率分别为91．1％和87．9％；住院期间2组均无严重出血及急性心脏缺血事件发生；出院前经超声心动图测得LVEF在溶栓治疗＋PCI组为64．8％，明显高于直接PCI组57．5％（P〈0．05）。结论 静脉溶栓治疗联合PCI治疗AMI合并2型DM早期再通率高。更有利于保护左室功能，不增加出血并发症。     

急性心肌梗死溶栓治疗前后QTd QTcd的比较

目的 探讨急性心肌梗死溶栓治疗成功是否与QTd、QTcd有关。方法 回顾性测量84例急性心肌梗死患者溶栓治疗后QTd、QTcd的变化，分析比较溶栓成功组与失败组QTd、QTcd值。结果 溶栓成功组与失败组及治疗前相比，QTd、QTcd有显著缩小p〈0．01；而失败组溶栓治疗后QTd、QTcd明显延长p〈0．01。结论 QTd可做为评估急性心肌梗死溶栓成功与否的指标之一。     

大剂量尿激酶冲击溶栓治疗视网膜中央动脉阻塞

目的 评价大剂量尿激酶冲击溶栓治疗视网膜中央动脉阻塞的疗效及安全性。方法 对19例病人在发病6h内经静脉给予溶于100ml 5％～10％葡萄糖液的150万U尿激酶进行溶栓治疗。2h后进行眼底荧光造影，观察溶栓及视力恢复情况。结果 19例中，10例视力恢复至0，5以上，4例0．2～0．5，3例0．05～0．1，2例病人治疗前无光感，治疗后无改善、经荧光造影证实10例血管完全再通，再通率52．6％，无严重并发症，结论 大剂量尿激酶冲击溶栓治疗视网膜中央动脉阻塞完全有效，其治疗效果大大好于传统治疗方法。     

局部动脉溶栓与中医药联合治疗急性颈内动脉系统脑梗死18例临床研究

目的:评价局部动脉溶栓与中医药联合治疗急性颈内动脉系统脑梗死的短期效果。方法:回顾性分析18例急性颈内动脉系统脑梗死接受局部动脉溶栓与中医药联合治疗病例的临床资料。结果:治疗效果好的患者有14例(78%),总的血管再通率为83%,出血率为16%,死亡率为11%,致残率为11%。结论:局部动脉溶栓与中医药联合治疗治疗急性颈内动脉系统脑梗死是一种有效方法,但安全性和远期疗效还有待于进一步研究和观察。     

Thrombolytic therapy followed by stenting for renal artery dissection secondary to blunt trauma

A 18-year-old man presented at our clinic with pain in the right flank following a motorbike accident. The diagnosis of renal artery dissection followed by thrombosis was made by computed tomography and confirmed by angiography. Successful revascularization was performed by means of repeated transcatheter injection of small doses of thrombolytic agents within the vessel, followed by deployment of a self-expandable stent. There were no complications, and the patient recovered well. Six months after stent placement, a selective renal angiogram showed excellent flow through the stented portion of the artery and normal parenchyma enhancement in the right kidney.     

Synergistic antithrombotic effect of a combination of NO donor and plasma kallikrein inhibitor

The aim of the present study was to investigate the effect of a NO donor (GSNO) and a plasma kallikrein inhibitor (PKSI-527) alone and in combination on global haemostatic status. A new in vitro test was employed which allows the measurement of both platelet function and spontaneous thrombolysis. Sixteen healthy young and 18 elderly volunteers were enrolled in this study. When GSNO (1 mM) or PKSI-527 (20 microM) was added to native human blood, platelet reactivity was significantly inhibited in both age groups. The combination of GSNO and PKSI-527 had additive inhibitory effect on platelets. Addition of either GSNO or PKSI-527 to blood samples did not significantly affect spontaneous thrombolysis, while added together, spontaneous thrombolysis was significantly enhanced. The thrombolysis enhancing effect was more prominent in elderly subjects. Our present findings suggest that the combination of NO donor and plasma kallikrein inhibitor may have clinical antithrombotic potential.     

Rupture of a thoracic aortic aneurysm: a rare adverse reaction following systemic tissue plasminogen activator infusion

We present a patient with rupture of a thoracic aortic aneurysm occurring after systemic infusion of tissue plasminogen activator for the treatment of acute ischemic stroke, which was successfully treated with the placement of an endovascular stent-graft.