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1.
尿激酶静脉溶栓治疗超早期脑梗塞的临床应用研究   总被引:5,自引:2,他引:3  
目的探讨尿激酶超早期静脉溶栓治疗急性脑梗塞的临床方法及疗效。方法按入选标准筛选合适病人进行溶栓,以相同时期非溶栓治疗的具有相同条件的患者为对照组。结果治疗组和对照组的完全加基本恢复率分别为45.7%和17.2%,差异有统计学意义(P=0.016)。溶栓组大面积脑梗塞完全恢复及基本恢复率为31.5%,明显优于对照组的0%(P=0.012)。两组出血率差异无统计学意义。结论只要严格掌握溶栓治疗时间窗、适应症、禁忌症、剂量,尿激酶静脉溶栓是安全有效的;尤其对于大面积脑梗塞具有不可比拟的疗效。由神经内科医生亲自床边监测TCD,有利于溶栓过程的用药指导及疗效判定,为提高溶栓恢复率和总有效率提供有力保证。  相似文献
2.
目的 通过对超早期脑梗死患者接受不同剂量重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的分析,探讨使用rt-PA对超早期脑梗死预后的影响。方法 超早期脑梗死患者308例,根据家属的意愿及是否签署溶栓治疗知情同意书分别给予溶栓治疗和非溶栓治疗。溶栓组221例,接受rt-PA静脉溶栓,其中92例给予rt-PA 0.9 mg/kg,发病在3 h内68例,>3~≤4 h内9例,>4~≤6 h内15例。129例给予rt-PA0.6~0.8 mg/kg,发病在3 h内72例,>3~≤4 h内24例,>4~≤6 h内33例。对照组87例,未应用rt-PA治疗。记录各组在基线、治疗24 h、发病90 dNIHSS评分、Barthel指数。预后良好定义为发病90 d Barthel指数≥95;颅内出血分为症状性颅内出血和非症状性颅内出血。同时记录随访期间的血管性死亡事件和卒中再发事件。应用logistic多因素分析预后的独立相关因素。结果 预后良好的独立相关因素为患者接受治疗前NIHSS评分(OR=2.067,95%CI 1.201~3.556,P =0.009),冠心病史(OR =1.942,95%CI 1.040~3.625,P =0.037)和溶栓治疗(rtPA 0.9 mg/kg时,OR =0.414,95%CI 0.207~0.826,P =0.012;rtPA 0.6~0.8 mg/kg时,OR =0.261,95%CI 0.137~0.497,P<0.01)。症状性颅内出血发生率在rtPA 0.9 mg/kg溶栓组与rtPA 0.6~0.8 mg/kg溶栓组分别为3.3%(3/92)和4.7%(6/129),差别无统计学意义。结论 静脉应用r t - PA溶栓治疗超早期急性脑梗死可获得较好的预后,不同剂量 r t - PA(0.6~0.8 mg/kg vs 0.9 mg/kg)对预后的影响无统计学差异,伴有心房颤动、糖尿病史将可能影响预后。  相似文献
3.
急性心肌梗死患者静脉溶栓治疗65例急诊护理   总被引:3,自引:1,他引:2  
目的 评价急诊经静脉rt-PA溶栓治疗急性心肌梗死的护理效果.方法 对65例急性心肌梗死急诊溶栓患者进行溶栓前后护理,以及正确的康复锻炼与出院指导.结果 65例患者通过急诊静脉溶栓后,大部分患者血管再灌通良好.参加早期锻炼的患者平均住院天数与并发症发生率明显下降.结论 急诊静脉溶栓是一种重建冠脉灌注非常有效的方法.正确的全程护理及出院注意事项是提高患者生存质量的保证.  相似文献
4.
目的 探讨重组组织型纤溶酶原激活剂(rt-PA)超早期静脉溶栓治疗急性脑梗死(ACI)的疗效及安全性.方法 对74例发病<6 h的ACI患者给予rt-PA(50 mg)静脉溶栓治疗,溶栓前及溶栓后30 min、24 h、14 d及3个月时分别采用美国国立卫生院卒中量表(NIHSS)评分,以及溶栓后3个月给予修订的Rankin评分(mRS)和日常生活能力Barthal指数(BI)评分,评价其疗效及安全性.结果 溶栓后各时间点NIHSS评分均有明显改善(均P<0.01);3个月时NIHSS≤1分者31例(41.9%),mRS 0~1分者39例(52.7%),BI 95~100分者33例(44.6%).脑出血发生率:<36 h 5例(6.8%),36~72 h 3例(4.1%).3个月内死亡9例(12.2%).结论 ACI发病6 h内给予rt-PA静脉溶栓治疗相对安全有效.  相似文献
5.
小剂量尿激酶溶栓治疗急性脑梗死临床观察   总被引:1,自引:0,他引:1  
目的观察尿激酶静脉溶栓治疗急性脑梗死的临床有效性及安全性。方法应用小剂量尿激酶超早期(发病6h内)静脉溶栓治疗急性脑梗死19例,于溶栓前及溶栓后24 h、10 d进行神经功能缺损及日常生活指数量表评分,同时观察脑内及其他系统有无出血并发症。结果溶栓后24 h神经功能缺损及日常生活指数评分与溶栓前相比均有改善,P<0.05;10d后神经功能缺损及日常生活指数评分与溶栓前相比进一步改善,P<0.01;发病3 h内溶栓组与3~6 h溶栓组在10 d时相比,前者溶栓痊愈率及有效率均高于后者。本组无1例有脑内及其他系统出血等并发症。结论小剂量尿激酶静脉溶栓治疗急性脑梗死其疗效较肯定,溶检开始时间越早,疗效越好,应用比较安全。  相似文献
6.
Between March 1996 and December 1997, 15 consecutive patients with carotid artery occlusion diagnosed with duplex sonography were treated with intravenous recombinant tissue plasminogen activator (rt-PA), following a protocol similar to that of the National Institute of Neurological Disorders and Stroke (NINDS) study. On the basis of ultrasound findings, six of the 15 patients had internal carotid artery dissection (ICD), and the remaining nine had atherothrombotic internal carotid artery (ICA) occlusion. No relevant haemorrhagic complications were observed after rt-PA treatment of ICA occlusion. Excellent late functional outcome was observed in three of the 15 patients with ICA occlusion, moderate and poor outcome in four patients. Four patients died, and mortality was related to stroke severity upon admission. A good outcome seemed to be more likely in the small group of patients with ICD, than in the patients suffering atherothrombotic ICA occlusion. As the results of rt-PA treatment in this case series are by no means devastating, our data do not corroborate the hypothesis that patients with acute ischemic stroke following ICA occlusion should a priori be excluded from intravenous thrombolysis. The possible benefit of rt-PA treatment in stroke following acute or chronic ICA occlusion should be assessed in a larger prospective trial, for which this case series might serve as a pilot study.  相似文献
7.
BACKGROUND: Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However, the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE: To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN: Observation experiment. SETTING: Department of Neurology, the 306 Hospital of Chinese PLA. PARTICIPANTS: Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology, the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients, 11 male and 4 female, were aged 46–79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease (1995) and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS: On admission, patients received thrombolysis with urokinase. Immediately after thrombolysis, skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin, mucous membrane and internal organs. Six hours later, low-dose low-intensity heparin 4–8 IU/kg per hour was intravenously administrated for anticoagulation for 7–10 days successively. MAIN OUTCOME MEASURES: Neurologic function was evaluated before, immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients (1995). Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS: Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time: Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis (t =3.45, P < 0.01). Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis, and neurologic deficits were increased, but no significant difference was found (P > 0.05). Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis (t =4.769, P < 0.01). ② Therapeutic effect and modified Rankin scale results: 14 days after thrombolysis, 4 patients were basically cured, 7 significantly improved, 2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis, according to modified Rankin Scale, score was 0 to 2 in 12 patients (80%), 3 to 4 in 2 patients (13.3%) and 6 in 1 patient (6.7%). Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION: Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.  相似文献
8.

Objective

Atrial fibrillation (AF) is associated with poor outcome after intravenous thrombolysis probably due to greater pretreatment stroke severity. We conducted this retrospective study to determine whether AF is an independent predictor for clinical outcome in patients stratified by initial stroke severity.

Methods

A total of 143 acute ischemic stroke patients who received intravenous thrombolysis within 3 h after onset were enrolled. The patients were categorized according to the baseline stroke severity by National Institute of Health Stroke Scale (NIHSS) score (≤10 vs. >10) and the presence of AF or not. Favorable 90-day outcome was defined as a modified Rankin Scale (mRS) score < 2.

Results

Among the 100 patients with severe stroke (NIHSS > 10), those with AF (n = 52) had a higher proportion of favorable 90-day outcome than those without AF (31% vs. 8%, P = 0.005). After adjustment for age, baseline glucose level, and onset to treatment time, the difference remained significant (odds ratio 5.80, 95% confidence interval 1.63–20.68). In patients with mild stroke (NIHSS ≤ 10), no difference in clinical outcome was found between AF (n = 20) and non-AF (n = 23) groups.

Conclusion

Presence of AF was associated with favorable 90-day outcome following intravenous thrombolysis in patients with severe stroke at baseline, while the association did not exist in patients with mild stroke.  相似文献
9.
10.
黄镪  武剑 《中国卒中杂志》2013,8(3):190-196
本文对急性缺血性卒中静脉溶栓治疗后出现症状性脑出血并发症的危险因素及相关预测模型进行综述,通过比较不同的预测模型的特点及其应用价值,以期为临床实践获得可靠的指导急性缺血性卒中治疗决策和选择合适静脉溶栓病例的量化辅助工具  相似文献
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