尿激酶静脉溶栓治疗急性脑梗死近期疗效观察

脑梗死急性期应用尿激酶静脉溶栓治疗疗效肯定，笔者探讨溶栓治疗入选标准和排除标准，使其更安全地应用于临床。[第一段]     

侧脑室体外引流配合腰穿治疗脑室出血20例分析

1995年以来，我院收治中、重度脑室出血20例，采用侧脑室穿刺体外引流、尿激酶灌注、腰椎穿刺放液治疗，效果良好，现总结如下：     

股动脉内注射尿激酶治疗下肢静脉栓塞

我院采取直接股动脉内注射尿激酶治疗下肢静脉栓塞取得满意疗效,现将2004年1月-2007年6月收治的50例患者资料报告如下: 1 资料与方法 1.1一般资料本组共50例患者,男性30例,女性20例,年龄22～12岁,平均42岁,其中内科高凝状态、风湿性心脏瓣膜病等原因所致21例,妇产科妊娠、分娩后5例,骨科下肢骨折及长期卧床所致6例,外科腹部手术及长期卧床所致8例,不明原因者10例,发病时间2～72 h,平均11h.     

奥扎格雷钠联合小剂量尿激酶治疗急性脑梗死的疗效观察

目的 观察奥扎格雷钠联合小剂量尿激酶治疗急性脑梗死的疗效.方法 选择颈内动脉系统急性脑梗死患者107例,随机分成2组,治疗组54例,对照组53例.治疗组奥扎格雷纳80mg加入生理盐水250ml静滴,1次/d,连用10d;尿激酶20万U加入生理盐水200ml静滴,1次/d,连用7d.对照组血塞通500mg,曲克芦丁0.6g分别加入生理盐水250ml中静滴,1次/d,连10d.治疗前后监测FG、PLT、PT、APTT、GPT、BUN.结果 治疗组总有效率90.74%,对照组75.47%.治疗后2组间神经功能缺损评分、总有效率有显著性差异,治疗组治疗前后PT、APTT、FG、GPT、BUN无变化.结论 奥扎格雷钠联合小剂量尿激酶治疗急性脑梗死安全有效.     

大剂量尿激酶静脉溶栓治疗急性心肌梗塞25例临床分析

目的 了解大剂量尿激酶静脉溶栓治疗急性心肌梗塞疗效.方法 对符合溶栓条件急性心肌梗塞25例病人,在常规治疗基础上,给予100万单位尿激酶静脉输注.结果 治愈23例,有效率92%.结论 使用大剂量尿激酶静脉溶栓治疗急性心肌梗塞,临床效果确切.     

重组织型纤维酶原激活剂与尿激酶静脉溶栓治疗急性ST段抬高心肌梗死的疗效比较

再灌注治疗是急性ST段抬高心肌梗死最主要的治疗方法,其中静脉溶栓因其方法简单、费用低廉、疗效确切一直备受人们关注.业已证实,粥样斑块破裂基础上血栓形成是急性心肌梗死(AMI)发生的主要病理基础.     

超早期颅骨锥孔尿激酶冲洗治疗脑出血102例

目的总结超早期颅骨锥孔尿激酶冲洗治疗脑出血的经验与教训。方法对102例发病在6h内的脑出血病人,采用颅骨锥孔置管后,用尿激酶冲洗引流。结果恢复正常29例(28.5%),轻残36例(35.3%),重残20例(19.6%),植物生存5例(4.9%),死亡12例(11.8%)。住院治疗期间无一例复发和颅内感染。结论超早期颅骨锥孔尿激酶冲洗治疗脑出血,血肿溶解迅速,引流效果好,且不会破坏患者凝血机制。     

^1H-magnetic resonance spectroscopy screening for animals with acute cerebral infraction suitable forthrombolytic therapy

BACKGROUND: As a non-invasive technique which can provide comprehensive biological information, 1H-magnetic resonance spectroscopy (1H-MRS) may provide valuable reference data for irreversible recovery or reversible changes in ischemic tissue after stroke. OBJECTIVE: To monitor and evaluate the effect of the urokinase thrombolytic therapy after experimental acute cerebral ischemia by 1H-MRS technology and investigate its adaptability. DESIGN: Randomly controlled animal study. SETTINGS: Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science. MATERIALS: Eleven healthy adult Sprague-Dawley (SD) rats, weighing 260–300 g and of both genders, were supplied by Experimental Animal Center of Tongji Medical Collage, Huazhong University of Science and Technology [SCXK (e) 2004-007]. 4.7T superconducting nuclear magnetic resonance meter was provided by Brucker Company. METHODS: The experiment was carried out in Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science from August 2003 to December 2005. ① The rats were randomly divided into 30-minute self-thrombo-embolism group (n =6) and 60-minute self-thrombo-embolism group (n =5). Six rats in 30-minute self-thrombo-embolism group were occluded with clot embolus for 30 minutes and 5 rats in 60-minute self-thrombo-embolism group were occluded for 60 minutes. 10 000 U/kg urokinase was dissolved in 2 mL saline and the operation lasted for 5 minutes. ② 1H-MRS was performed before thrombolysis and at 3 hours and 24 hours after successful embolization. The metabolic changes of N-acetyl-L-aspartic acid (NAA)/phosphocreatine (PCr) + creatine (Cr), choline phosphate (Cho)/PCr+Cr and lactic acid (Lac)/PCr+Cr in the region of interests were analyzed. ③ The T2W image was conducted 24 hours after the thrombolytic therapy with TR=500 ms and TE=25 ms. ④ The subjects were sacrificed immediately after 1H-MRS and the brain tissues were cut into pieces and stained with HE method; in addition, pathological changes were observed under optic microscope. MAIN OUTCOME MEASURES: ① Metabolic changes of NAA/PCr+Cr, Cho/PCr+Cr and Lac/PCr+Cr in the region of interests; ② T2W image at 24 hours after the thrombolysis; ③ pathological observation of brain tissue. RESULTS: Eleven rats were all involved in the final analysis. ① Metabolic changes in the region of interests : In 30-minute self-thrombo-embolism group, the Lac peak emerged immediately after the embolism, but the ischemic zone decreased 3 hours after the thrombolytic therapy (0.252±0.01, 0.603±0.01, P < 0.01). Lac/(PCr+Cr) ratio was 0.290±0.01 at 24 hours after thrombolysis, which was higher than that at 3 hours after thrombolysis (P < 0.01). The NAA/ (PCr+Cr) ratio decreased significantly at 3 hours after the thrombolysis as compared with that before thrombolysis (0.922±0.16, 1.196±0.01, P < 0.05). In 60-minute self-thrombo-embolism group, the Lac/(PCr+Cr) ratio was higher at 3 hours after thrombolysis than that before thrombolysis (0.846±0.12, 0.601±0.11, P < 0.05) and the NAA/(PCr+Cr) decreased at 3 hours after the embolism. Fluctuation of NAA/ (PCr+Cr) ranged from 0.68 to 0.75 before thrombolysis and from 0.71 to 0.75 at 3 hours after thrombolysis. ② T2W image: T2W image showed that 2 subjects in 30-minute self-thrombo-embolism group whose Lac/NAA was higher than 0.7 suffered from intracranial hemorrhage. This meant that the subjects with Lac/NAA > 0.7 were more likely to suffer from intracranial hemorrhage. ③ Histological and morphological examinations: Optic microscope demonstrated that interspace surrounding nerve cells was widened at ischemic center; neurons were swelling; nucleus was stained lightly; pyknosis and mesenchymal edema were mainly observed in lateral cortex of brow and vertex and in lateral part of corpus striatum. CONCLUSION: ①Compound parameters in ischemic area before thrombolysis should be regarded as an important predicting marker for thrombolytic therapy, effect evaluation and termination. ② 1H-MRS combining with other imaging technique is a detecting way for screening cases who are suitable for thrombolytic therapy.     

蝮蛇抗栓酶与尿激酶治疗脑梗塞50例对比观察

1对象与方法 1．1一般资料甲组：男13例，女12例，年龄40-74岁，乙组：男16例，女9例，年龄40-65岁（甲组取1993年5月至1994年4月，乙组为1992年4月至1993年1月住院患者）。全组发病年龄50-65岁者40例，占80％，急性期（1～14天）甲组21例，乙组19例，稳定期（15-30天）甲组4例，乙组6例。     

中心静脉导管内注入尿激酶治疗结核性包裹性胸膜炎

目的探讨中心静脉导管内注入尿激酶治疗结核性包裹性胸膜炎的疗效。方法将收治的108例结核性包裹性胸膜炎患者随机分为治疗组与对照组,治疗组在胸膜腔内置入中心静脉导管并注入尿激酶,对照组每周2～3次胸穿抽液并注入尿激酶。化疗方案等其他治疗方法相同。结果治疗组胸液消失天数为8.58±2.84,对照组为12.42±4.17,P<0.05;治疗组抽放胸液总量(3495±1136)ml,对照组(2031±1135)ml,P<0.01;治疗组抽液次数为5.33±1.37,对照组为4.83±1.53,P>0.05。在肺功能方面肺活量、用力肺活量、第1秒用力呼气容积、肺总量。胸水吸收前差异无显著性(P>0.05),胸水吸收后差异有显著性(P<0.01),治疗组肺功能改善较对照组快。在凝血指标方面,全部病例胸液纤维蛋白原治疗后明显低于治疗前(P<0.05);而其它凝血指标无统计学差异。结论在正规抗结核治疗下配合中心静脉导管内注入尿激酶,治疗结核性包裹性胸膜炎能显著增加引流量,明显改善肺功能,而对凝血指标改变不明显。