静脉溶栓治疗对急性脑梗死患者氧化应激指标与神经功能影响

目的 探讨静脉溶栓治疗急性脑梗死患者的临床疗效及对氧化应激指标与神经功能的影响。方法 选择本院2015 年1 月～2018 年12 月收治的以急性脑梗死为诊断的患者80 例,抽签法分为对照组（n=40）与实验组（n=40）,其中对照组患者采取常规治疗（抗自由基、抗血小板聚集）,实验组患者采取静脉溶栓治疗。对两组患者治疗前后氧化应激指标（SOD、MDA）、神经功能指标（NIHSS）、肢体运动功能及治疗疗效进行比较。结果 治疗前,两组患者机体内氧化应激反应指标、神经功能指标NIHSS、Barthel 评分比较,差异无统计学意义（P＞0.05）。治疗后,两组患者机体内氧化应激反应指标均明显改善,其中实验组患者SOD 反应指标明显高于对照组,而MDA指标明显低于对照组,两组患者在治疗后NIHSS 评分明显降低,Barthel 评分明显升高,其中实验组患者明显优于对照组,实验组患者治疗后临床总有效率为92.50%,高于对照组的65.00%,差异有统计学意义（P＜0.01）。实验组患者治疗期间并发症发生率为7.50%,高于对照组的5.00%,经对症治疗后症状消失,但差异无统计学意义（P＞0.05）。结论 在急性脑梗死患者的治疗中,采取静脉溶栓治疗,可明显减轻患者机体内氧化应激指标,改善神经功能,提高肢体运动功能,提高临床治疗效果。     

急性前循环颅内外串联闭塞血管内治疗预后相关因素分析

目的探讨急性前循环颅内外串联闭塞(TO)血管内治疗方法,分析其预后相关因素。方法回顾性收集2016年1月～2019年4月我院神经外科收治的急性颈内动脉颅内外段闭塞伴同侧大脑中动脉闭塞患者的临床资料,将患者分为预后良好组(90 d mRS评分0～2分)和预后不良组(90 d mRS评分3～6分)。比较两组发病年龄、手术前后NIHSS评分、ASPECT评分、侧支循环、闭塞类型、开通顺序、术中替罗非班使用、有效再通率、术后出血转化率、术后7 d NIHSS评分、术后90 d mRS评分等临床指标,并对结果进行统计学分析。结果共确认21例[(10.6%(21/198)]急性前循环颅内外串联闭塞患者,其中预后良好组8例(38.1%),预后不良组13例(61.9%)。两组高血压、高脂血症、吸烟和肺部慢性疾病、入院NIHSS评分、术前ASCEPT评分、病因TOAST分型等术前评估指标比较,无统计学差异(P0.05);与预后不良组相比,预后良好组年龄更低(P=0.009)。两组术后7 d NIHSS评分比较,差异有统计学意义(t=-2.536,P=0.020),术中替罗非班的使用、症状性颅内出血无明显差异(P0.05)。21例患者有效再通率为(TICI 2b-3)71.5%,死亡率28.6%,仅38.1%的患者预后良好。两组再灌注TICI分级无统计学差异(P=0.336),较低的发病年龄(P=0.009)、良好侧支循环(P=0.037)、术后7 d NIHSS评分(P=0.020)及桥接静脉溶栓(P=0.011)与预后相关。多因素Logistic回归分析显示,侧支循环为预后预测因子(B=3.651,OR=38.5,95%CI为2.951～508.463,P=0.006)。结论前循环急性颅内外串联闭塞患者进行血管内治疗有一定效果,但总体良好预后率偏低,良好侧支循环为预后较强预测因子。本研究的局限性主要为非随机单中心回顾性研究,TO患者最佳治疗策略需要更多的随机对照进一步研究探索。     

Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial--PRAGUE-2.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted. METHODS: The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n=421) or immediate transport for primary percutaneous coronary intervention (PCI group, n=429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0-3 h and 3-12 h after symptom onset. Maximum transport distance was 120 km. RESULTS: Five complications (1.2%) occurred during the transport. Randomization-balloon time in the PCI group was 97+/-27 min, and randomization-needle time in the TL group was 12+/-10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P=0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n=551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003). CONCLUSIONS: Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.     

Low molecular weight heparin (Fragmin(R)) prevents early reocclusion following femoral artery thrombolysis with rt-PA in rabbits

The purpose of this study was to evaluate the effect of lowmolecular weight heparin Fragmin on thrombolysis with tissue-typeplasminogen activator (rt-PA) and to compare its effect to thatof standard heparin. A rabbit thrombosis model was used, consistingof a blood clot produced in an isolated femoral artery segmentwith superimposed endothelial damage and distal stenosis. Thirtyrabbits were randomized to three treatment groups with rt-PA(30 µ.g. kg^–1. min^–1 for 60 min and no additionaltherapy), rt-PA with Lv. standard heparin (200 IV. Kg^–1bolus and then 70 IU. Kg^–1 hourly) and rt-PA with s.c.Fragmin (a single dose of 500 IU. Kg^–1) prior to rt-PAadministration. In six of 10 rabbits given rt-PA only, recanalizationwas observed, which was persistent in three. In eight of 10rabbits given rt-PA with intravenous heparin, reflow was achieved,which was persistent in three. Fragmin resulted in recanalizationin eight of 10 rabbits, with persistent patency in each recanalizedrabbit. Reflow time was not shortened with either standard heparinor Fragmin compared with rt-PA alone (64±41, 56 ±18, 50 ±23 min respectively), (P=0·7). Persistentreocclusion after reflow was not observed with Fragmin (0/8)but was present with both standard heparin (518, P=0·03vs Fragmin) and rt-PA alone (316, P=0·05 vs Fragmin). Thus, in the femoral artery of the rabbit, Fragmin, unlike standardheparin, was found to prevent reocclusion following rt-PA thrombolysis.     

冠状动脉内超声溶栓治疗急性冠脉综合征的临床观察

目的　探讨低频高能超声溶解急性冠状动脉综合征(ACS)闭塞相关血管或“罪犯”血管血栓及粥样硬化斑块的有效性和安全性。　方法　ACS患者26例,其中ST段抬高急性心肌梗死19例,非ST段抬高心肌梗死3例,不稳定性心绞痛4例;左前降支闭塞 10 例,左冠状动脉闭塞 4 例,右冠状动脉闭塞5例。超声溶栓后对闭塞相关血管行急诊经皮冠状动脉腔内成形术。　结果　超声溶栓后,闭塞相关血管前向血流达心肌梗死溶栓试验3 级 19 例,开通 19 例,开通率为 73%(19/26),其中冠状动脉左前降支成功率最高。超声溶栓成功患者胸痛能完全缓解,心电图ST段下降50%以上,但术后残余狭窄平均为(73±11)%。急诊经皮冠状动脉腔内成形术后6例,残余狭窄降至(13±7)%(P<0. 05)。在超声溶栓中,7例出现并发症。　结论　低频高能超声可有效、安全溶解闭塞相关血管血栓,对富含血栓的病变可进行超声溶栓,可作为经皮冠状动脉腔内成形术的互补手段在临床应用。     

Plasminogen activator inhibitor 1: Molecular aspects and clinical importance

Plasminogen activator inhibitor-1 (PAI-1) is the major physiologic inhibitor of plasminogen activation in plasma and in the blood vessel wall. PAI-1 exhibits distinctive structural and functional properties that have been extensively studied over the past decade. Aside from the physiological role of PAI-1, there is accumulating evidence that increased production of PAI-1 may contribute to the development of ischemic cardiovascular disease. Efforts are now underway to develop and test specific inhibitors of PAI-1.     

Prediction of degree of residual stenosis in coronary thrombolysis

In order to predict the residual stenosis in coronary thrombolysis, the factors easily obtained from clinical history--age, gender, history of angina before acute myocardial infarction (AMI), family history, hypertension, diabetes, hypercholesterolemia, smoking, and interval between onset of AMI and recanalization--were observed in 114 patients with successful coronary thrombolysis. In 55 patients with angina before AMI, 29 patients had residual stenosis greater than or equal to 75% and 26 patients had residual stenosis less than 75%. In 59 patients without angina before AMI, 15 patients had residual stenosis greater than or equal to 75%, and 44 patients had residual stenosis less than 75%. The presence or absence of angina before AMI was the main variable that discriminated the groups of residual stenosis of more or less than 75%, which was the only significant independent variable to predict the residual stenosis. These data suggest that the presence of angina pectoris before AMI is likely to be associated with a significant degree of residual stenosis after thrombolysis.     

A dual-purpose angioplasty-drug infusion catheter for the treatment of intragraft thrombus

An investigational angioplasty-drug infusion catheter (Transport, CardioVascular Dynamics, Irvine, CA) was used to treat a saphenous vein graft stenosis associated with a thrombus. The catheter was successfully used both to infuse urokinase at the site of angioplasty and to perform effective angioplasty, demonstrating the feasibility and utility of a dual-purpose angioplasty catheter capable of angioplasty and/or local drug infusion with the same catheter. © 1994 Wiley-Liss,Inc..     

经导管溶栓与经足背静脉溶栓治疗下肢深静脉血栓形成的对比分析

目的：对比经导管溶栓与经患肢足背静脉顺行溶栓治疗急性下肢深静脉血栓形成的疗效及安全性。方法回顾性分析60例经造影明确诊断的急性下肢深静脉血栓形成患者的临床资料,其中采用经导管溶栓治疗的患者为A组（30例）,采用经患肢足背静脉顺行溶栓治疗的患者为B组（30例）。对比两组患者的治疗效果、患肢消肿率、深静脉通畅度等。结果两组均成功完成溶栓治疗。患肢消肿率A组为（82.39％±16.28％）,B组为（62.58％±18.87％）;静脉通畅度A组为（62.18％±18.39％）, B组为（39.28％±23.36％）,差异均有统计学意义（P＜0.05）。结论经导管溶栓治疗急性下肢深静脉血栓形成较经患肢足背静脉顺行溶栓疗效好,可部分取代经患肢足背静脉顺行溶栓治疗。