尿激酶动脉溶栓联合支架置入术与单纯尿激酶动脉溶栓治疗缺血性卒中的比较

Objective To compare the safety and efficacy of intra-arterial urokinase thrombolysis alone and intra-arterial urokinase thrombolysis + stenting for ischemic stroke. Methods Sixty-four patients with acute cerebral infarction in the internal carotid artery system were analyzed retrospectively. The patients were divided into intra-arterial thrombolysis group (n = 38; using urokinase only) and stenting group (n = 26; using urokinase + stenting). The medical and imaging data of the patients in both groups were collected. The revascularization rate, and symptomatic intracranial hemorrhage and/or mortality rates were compared. The modified Rankin Scale (mRS) scores at 3 months were used to evaluate the clinical outcome in both groups. Results Of the 64 patients with ischemic stroke, 55 (85. 9%) had vascular occlusion, 9 (14. 0% ) had severe arterial stenosis. The revascularization rate in the thromborysis group was 47.4% (18/38), and that in the stenting group was 88.5% (23/26). Compared to the drug thrombolysis group, the proportion of patients whose mRS scores ＜2 at 3 months after procedure (47. 4% vs. 73. 1%,χ2 = 4. 18,P = 0. 00). There was no significant difference between the symptomatic intracranial hemorrhage rate and death rate (7. 8% vs. 7.7% , χ2 = 0.00, P =0. 62). Conclusions When patients with acute ischemic stroke are treated with ultra-early endovascular treatment, the revascularization rate of the occlusion and severe artery stenosis treated with mechanical recanalization + stenting was significantly higher than that of the simple intra-arterial thrombolytic drug, and the long-term clinical outcome is better.     

尿激酶动脉溶栓与重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性卒中的疗效比较

目的 评价尿激酶动脉溶栓与重组组织纤溶酶原激活剂(recombinant tissue plasminogen activator,rtPA)静脉溶栓治疗急性缺血性卒中的疗效和安全性.方法 发病6 h内的急性脑梗死患者43例,其中动脉溶栓组31例行超选择性动脉溶栓,静脉溶栓组12例行rtPA静脉溶栓.观察动脉溶栓组血管再通.90 d时改良Rankin量表(modified Ranlkin scale,mRS)评分评价2组转归.结果 动脉溶栓组完全再通18例(58.1%),部分再通7例(22.6%),血管再通率为80.6%,并发有症状颅内出血3例,死亡1例.尿激酶动脉溶栓组与rtPA静脉溶栓组90 d时转归良好率(74.2%对66.7%,x2=0.24,P=0.622)和有症状颅内出血发生率(9.68%对8.33%,x2=0.19,P=0.892)均无显著差异.结论 在治疗时间窗内尿激酶动脉溶栓能显著提高闭塞血管再通率,改善患者急性期临床症状和远期转归,近期疗效和远期转归均与rtPA静脉溶栓相当.     

超选择动脉内溶栓治疗脑急性缺血性卒中

目的探讨脑急性缺血性卒中患者动脉内溶栓治疗的安全性和有效性。方法回顾1997年7月至2002年7月脑急性缺血性卒中患者165例，男97例，女68例。年龄32～74岁，平均为58岁。采用超选择动脉内溶栓方法，起病距溶栓的时间为2～24h。尿激酶以1～1．2万U／min持续泵入，总量为50万-130万U，平均85万U。结果颈内动脉系统血管闭塞108例，椎-基底动脉系统闭塞27例，脑血管造影未见明显异常30例。闭塞血管再通者，颈内动脉14例，大脑中动脉27例，大脑中动脉分支28例，椎-基底动脉系统19例。10例因明显的血管狭窄，溶栓后给予球囊扩张、支架置入术。神经系统症状完全恢复正常或明显好转105例，并发脑出血6例，消化道出血13例。结论超选择动脉内溶栓可使血栓局部迅速达到较高的血药浓度，用药总量小，疗效好，见效快，是治疗脑急性缺血性卒中的有效方法。     

动脉溶栓辅助支架置入术治疗急性脑梗死

目的 观察动脉溶栓辅助血管内支架成形术治疗急性脑梗死的效果.方法 采用前瞻性病例对照设计,将24例动脉溶栓后遗留血管狭窄(＞50%)的急性脑梗死患者分为支架治疗组和药物治疗组,分别给予支架成形术+药物治疗和常规药物治疗,评价两组血管完全再通率、残余狭窄率以及3个月时改良Rankin量表评分.结果 支架治疗组血管完全再通率高于药物治疗组(54.5%对0%,χ2=6.382,P＜0.001),残余狭窄率显著低于药物治疗组(4.5%±5.2%对82.5%±10.5%,t=7.464,P＜0.001),临床转归良好率显著高于药物治疗组(100%对76.9%,χ2=14.263,P=0.038).结论 动脉溶栓辅助血管内支架治疗急性脑梗死疗效优于药物治疗组,且较为安全.

Abstract：

Objective To investigate the efficacy of intra-arterial thrombolysis with stenting for acute cerebral infarction. Methods Using a prospective case-control design, 24 patients with acute cerebral infarction who remained angiostegnosis ( ＞ 50%) after intra-arterial thrombolysis were randomly divided into stent treatment group and drug treatment group. They were treated with stenting + drug treatment and conventional drug treatment. The rates of vascular complete revascularization and residual stenosis, and the modified Rankin scale scores at 3 months in both groups were evaluated. Results The rate of complete revascularization in the stent treatment group was significantly higher than that in the drug treatment group (54. 5% vs.0%,χ2 =6.382, P ＜0. 001), and the rate of residual stenosis was significantly lower than that in the drug treatment group ([4.5 ±5.2]% vs. [82. 5 ±10. 5]%, t =7.464, P＜0.001). The rate of favorable clinical outcome in the stent treatment group was significantly higher than that in the drug treatment group (100% vs. 76. 9%,χ2 = 14. 263, P = 0.038). Conclusion The efficacy of intra-arterial thrombolysis with stenting in the treatment of acute cerebral infarction is superior to that in the drug treatment group, and it is safer.     

静脉溶栓治疗对急性缺血性卒中患者卒中后抑郁的影响

作为急性缺血性卒中最有效的治疗手段,静脉溶栓不但可以改善患者转归,还可能通过直接或间接机制影响卒中后抑郁（post-stroke depression, PSD）。因此,深入探索静脉溶栓对PSD的影响具有重要的临床意义。文章围绕PSD的特点、静脉溶栓对PSD的可能影响、机制以及PSD的防治进行了综述。     

动脉溶栓辅助支架置入术治疗急性脑梗死

Objective To investigate the efficacy of intra-arterial thrombolysis with stenting for acute cerebral infarction. Methods Using a prospective case-control design, 24 patients with acute cerebral infarction who remained angiostegnosis ( ＞ 50%) after intra-arterial thrombolysis were randomly divided into stent treatment group and drug treatment group. They were treated with stenting + drug treatment and conventional drug treatment. The rates of vascular complete revascularization and residual stenosis, and the modified Rankin scale scores at 3 months in both groups were evaluated. Results The rate of complete revascularization in the stent treatment group was significantly higher than that in the drug treatment group (54. 5% vs.0%,χ2 =6.382, P ＜0. 001), and the rate of residual stenosis was significantly lower than that in the drug treatment group ([4.5 ±5.2]% vs. [82. 5 ±10. 5]%, t =7.464, P＜0.001). The rate of favorable clinical outcome in the stent treatment group was significantly higher than that in the drug treatment group (100% vs. 76. 9%,χ2 = 14. 263, P = 0.038). Conclusion The efficacy of intra-arterial thrombolysis with stenting in the treatment of acute cerebral infarction is superior to that in the drug treatment group, and it is safer.     

动脉溶栓联合血管成形术治疗急性缺血性卒中的单中心研究

目的 总结急性缺血性卒中患者早期动脉溶栓联合血管成形术的经验,评价该方法治疗急性缺血性卒中的安全性和有效性.方法 回顾性分析首都医科大学宣武医院介入放射诊断治疗科2000年1月-2010年9月,行动脉溶栓联合血管成形术治疗的98例急性缺血性卒中患者的临床资料,评估其疗效、围手术期的并发症以及随访情况.结果 ①所有患者均在动脉溶栓后行血管成形术,技术成功率达100%,术后血管再通率达100%;②围手术期出现蛛网膜下腔出血5例,脑内血肿9例,动脉夹层8例,急性/亚急性再闭塞4例,前、后循环并发症的发生率以及出血性并发症的发生率比较,差异无统计学意义,P〉0.05;③所有患者术前NIHSS评分为16.1±3.8,术后90 dNIHSS评分为6.7±7.7,差异有统计学意义,P〈0.01;④术后90d预后良好者有60例,预后中等者有18例,预后差者有20例,其中死亡12例.后循环患者预后差的比例高于前循环患者（46.7%对8.8%）,差异有统计学意义,P〈0.01.后循环患者的病死率高于前循环患者（26.7%对5.9%）,差异有统计学意义,P〈0.01.结论 动脉溶栓联合血管成形术在技术层面上是可行的,可以提高早期血管再通率,改善患者的预后.     

影响青岛地区急性缺血性卒中患者溶栓治疗的因素

目的 明确青岛地区缺血性脑血管病患者的溶栓率,并分析影响溶栓治疗的原因,探讨其影响因素.方法 制定统一的青岛市卒中诊治现状调查表,回顾性连续收集2008年10月1日至2009年10月31日就诊于青岛市、县两级具有溶栓条件的11家医院神经内科的急性卒中住院患者,进行面对面问卷调查,收集其临床资料,分析影响溶栓治疗的因素.结果 实际调查缺血性脑血管病患者864例,仅10例患者接受溶栓治疗,溶栓率为1.16%,4.5 h治疗时间窗内的溶栓率为6.33%.Logistic回归分析显示,除溶栓禁忌证外,影响急性缺血性卒中患者溶栓治疗的因素还包括就诊医院级别(OR=0.061,95% Cl0.006～0.703,P=0.040)和就诊时美国国立卫生研究院卒中量表评分(OR=0.810,95%CI0.729～0.900,P=0.000).结论 青岛地区缺血性脑血管病患者的溶栓率偏低;除溶栓禁忌证外,影响急性缺血性卒中患者溶栓治疗的因素还包括就诊医院级别和就诊时美国国立卫生研究院卒中量表评分.     

血细胞对静脉溶栓治疗的急性缺血性卒中患者转归的预测价值

越来越多的研究表明,外周血细胞计数,包括中性粒细胞、嗜酸性粒细胞、单核细胞、淋巴细胞、红细胞、血小板计数以及相关比值,与急性缺血性卒中患者静脉溶栓后的临床转归相关。因此,作为预测卒中患者转归的生物标志物,外周血细胞计数及相关比值具有重要的临床应用价值。文章对血细胞计数及相关比值对急性缺血性卒中患者静脉溶栓后转归的预测价...     

急性缺血性卒中溶栓治疗进展

急性缺血性卒中具有发病率、死亡率和致残率高的特点,溶栓疗法是目前唯一能在急性期改善患者预后的治疗方法.文章就时间窗的选择、溶栓的主要方法和药物、溶栓治疗后血管再通的并发症等进行了综述.     

急性缺血性卒中动脉溶栓治疗的远期转归及其影响因素——回顾性病例系列研究

目的 探讨急性缺血性卒中患者动脉溶栓治疗的远期转归及其影响因素.方法 纳入接受动脉溶栓的急性缺血性卒中患者,利用改良Rankin量表(modified Rankin Scale,mRS)评价溶栓治疗90d时的神经功能转归,根据评价结果分为转归良好组(mRS评分0～2分)和转归不良组(mRS评分3～6分);根据急性心肌梗...     

尿激酶动脉溶栓与重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中的疗效比较

目的 评价选择性动脉溶栓治疗急性脑梗死的疗效和安全性.方法 回顾性分析发病6 h内的急性脑梗死患者43例的临床资料,其中动脉溶栓组31例,静脉溶栓组12例.动脉溶栓组患者在发病6 h内经DSA证实为颅内血管闭塞,并进行超选择性动脉溶栓治疗(尿激酶总量<75万U);静脉溶栓组患者于发病3 h内接受重组组织型纤溶酶原激活剂...     

脑白质高信号部位对急性缺血性卒中静脉溶栓患者临床转归的影响

目的:探讨脑白质高信号(white matter hyperintensities, WMHs)部位对前循环急性缺血性卒中(acute ischemic stroke, AIS)静脉溶栓患者临床转归的影响。方法:回顾性纳入2015年2月至2020年2月在徐州市中心医院接受阿替普酶静脉溶栓治疗的前循环AIS患者。根据Fa...