尿激酶静脉溶栓治疗超早期脑梗塞的临床应用研究

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。

Clinical application of intravenous thrombolysis with urokinase in treating cerebral infarction at the super-early stage

Objective To evaluate the therapeutic efficacy of intravenous thrombolysis with urokinase in the treatment of cerebral infarction at the super-early stage. Methods Intravenous thrombolytic therapy was performed on 35 patients as a thrombolysis-treated group who are up to the admission standards, and meanwhile 29 patients as a control group with the similar conditions to the thrombolysis-treated group were managed without intravenous thrombolsis. Results The complete or nearly complete recovery rate in thrombolysis-treated group was 45.7 %, significantly higher than that in control group being 17.2 % (P=0.016). Thrombolysis-treated group had a markedly higher rate of complete or nearly complete recovery in patients with extensive cerebral infarction than the control group, 31.5 % vs 0 % (P=0.012). There was no significant difference in hemorrhage rate between the two groups. Conclusion Provided therapeutic time window, indications, contraindications and dosage were well controlled, intravenous thrombolytic therapy with urokinase was safe and effective in the treatment of cerebral infarction, particularly for patients with extensive cerebral infarction. Bedside monitoring with transcranial Doppler (TCD) in thrombolytic treatment helped to direct administration of urokinase and evaluate the therapeutic efficacy, and improve the recovery rate and the total effective rate of thrombolysis.