rt-PA溶栓治疗急性缺血性脑卒中临床效果及影响因素分析

目的探讨重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗急性缺血性脑卒中(AIS)的临床效果及影响因素。方法回顾性分析2016年1-12月我院收治的48例AIS患者的临床资料。所有患者均于发病6 h内行rt-PA溶栓治疗。应用动脉闭塞评分评价溶栓效果,根据溶栓效果将患者分为有效组(A组)与无效组(B组)。比较两组患者血糖、收缩压、甲状腺激素T3水平、发病至治疗时间(OTT)、心源性卒中例数及美国国立卫生研究院卒中量表(NIHSS)评分。多因素Logistic回归分析rt-PA溶栓治疗效果的影响因素。结果 A组患者血糖、收缩压、甲状腺激素T3水平、OTT及NIHSS评分低于B组,差异均有统计学意义(P<0.05);心源性卒中比例高于B组,差异有统计学意义(P<0.05)。NIHSS评分、OTT与溶栓效果呈负相关(r值分别为-0.076与-0.083,P均<0.05);甲状腺激素T3水平与溶栓效果呈正相关(r=0.037,P<0.05)。A组患者治疗后24 h神经功能恢复良好比例及7 d转归良好比例均高于B组,差异有统计学意义(P<0.05)。结论 NIHSS评分、甲状腺激素T3水平及OTT是rt-PA溶栓治疗AIS的独立影响因素,具有临床指导意义。     

静脉溶栓救治急性心肌梗死22例

人体重组组织型纤溶酶原激活剂 (rt PA)静脉溶栓治疗急性心肌梗死 (AMI)成功率 82 %左右[1] 。我科自 1998年至今 ,静脉溶栓救治急性心肌梗死2 2例 ,初溶 17例成功 ,为了进一步提高溶栓成功率 ,挽救难溶性重症急性心梗病人生命 ,对初始溶栓后 90min尚未溶栓成功的 5例 ,立即追加静滴 ,直到溶栓成功 ,取得了满意效果。1　临床资料1 1　一般情况　急性心肌梗死 2 2例 ,均为男性 ;年龄 6病 部颁布的临床疾病诊断标准[2 ] 。非ST段抬高急性心梗从本组中排除。发病后至溶栓时间4 0min～ 2 10min ,平均 15 0min。 2 2例均除外出血性疾病、活动…     

t－PA、PAI与缺血性脑血管疾病

ｔ－ＰＡ、ＰＡＩ与缺血性脑血管疾病武警新疆总队医院内一科李卫综述吴宣富审校（乌鲁木齐８３００００）关键词组织型纤溶酶原激活剂，纤溶酶原激活剂抑制剂，缺血性脑血管疾病缺血性脑血管疾病（ＩＣＶＤ）的主要病理基础是动脉粥样硬化（ＡＳ），凝血与纤溶系统平衡紊...     

重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的临床疗效观察

目的：分析重组组织型纤溶酶原激活剂（ Recombinant tissue－type plasminogen activator,rt－PA）溶栓治疗急性脑梗死（ Acute cerebral infarction,ACI）的临床效果。方法选取静脉溶栓治疗的242例ACI病例,随机分为rt－PA组（ rt－PA治疗）和对照组（奥扎格雷钠溶栓治疗）,静脉给药治疗2周,对比分析组间NIHSS评分、mRS和颅内出血发生率。结果 rt－PA组NIHSS评分、mRS均显著低于对照组,颅内出血率以及病死率和对照组接近（P＜0.05）,组间存在显著区别。结论 rt－PA静脉溶栓不仅效果显著,而且安全性可靠,是ACI较为理想的早期溶栓治疗药物,建议推广。     

高龄缺血性卒中rt-PA静脉溶栓研究

目的:探讨高龄(年龄＞80岁)缺血性卒中患者行rt-PA静脉溶栓是否安全、可行.方法回顾性比较新疆生产建设兵团医院神经内科脑卒中数据库中34例高龄(年龄＞80岁)和55例适龄(18岁≤年龄≤80岁)缺血性卒中患者rt-PA静脉溶栓诊治过程,根据美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)和改良Rankin量表评分(modified Rankin score,mRS)、生活能力指数(Barthel index,BI),观察不良反应事件.结果:两年龄组溶栓前后NIHSS评分、mRS、BI均有统计学差异(p＜0.05),提示溶栓对高龄患者也获益,是可行的.两年龄组溶栓后各种出血性不良反应均无统计学差异(p＞0.05),说明对于高龄患者溶栓是安全的.34例高龄患者痊愈29例(90天mRS评分1.45分),3例90天mRS评分5分.除外1发生血尿外,无严重出血并发症,无1例发生症状性颅内出血(symptomatic intracranial haemorrhage,SICH).结论:高龄(年龄＞80岁)缺血性卒中进行rt-PA静脉溶栓是可行且较安全的.     

西宁地区急诊室内重组组织型纤溶酶原激活剂与尿激酶治疗急性心肌梗死的疗效分析

目的：观察重组组织型纤溶酶原激活剂（rt-PA）与尿激酶（UK）治疗西宁地区急性心肌梗死（AMI）的疗效.方法：按溶栓药物不同将60例AMI病人随机分为两组.rt-PA组（30例）,先给rt-PA 15mg,余量35mg用微量泵于30min内泵入,继以50mg于60min内泵入,特殊情况可适当加量;UK组（30例）,将UK150万单位于30min内泵入.结果：rt-PA组血管再通率为80.0％,UK组为53.3％,两组比较差异有显著性（x2=4.800,P＜0.05）;出血并发症的发生,rt-PA组为10.0％,UK组为13.3％,两组比较无显著性差异（x2=0.16,P＞0.05）.住院四周的病死率rt-PA组为6.7％,UK组为10.0％,两组比较无显著性差异（x2=0.22,P＞0.05）.结论：西宁地区rt-PA溶栓疗效优于UK,尤其是在患者发病后3h内进行溶栓治疗效果更佳,不增加出血风险,四周住院病死率无增加.     

院内急性缺血性脑卒中急诊闭塞开通救治延误原因分析

目的探讨院内急性缺血性脑卒中急诊血管内开通救治延误的原因。方法回顾性分析2018年1月至2019年12月在河南省人民医院住院期间发生急性大动脉闭塞性脑梗死并接受急诊血管内治疗患者临床资料。根据患者发病至股动脉穿刺时间分为延误组>120 min和非延误组≤120 min。收集两组患者基线资料、术中影像及术后90 d改良Rankin量表(mRS)评分,分析院内脑卒中血管内开通救治延误的原因。结果共纳入院内脑卒中患者34例(延误组n=22,非延误组n=12),中位年龄68.0(56.0,73.5)岁,其中男24例(70.6%)。中位发病至股动脉穿刺时间(OPT)为233(110.7,300.0) min。非延误组发病至会诊时间(42.0 min比137.0 min,P<0.001)、影像检查至股动脉穿刺时间(43.0 min比130 min,P<0.001)均显著短于延误组;出院时美国国立卫生研究院卒中量表(NIHSS)评分(6.5比10.0, P=0.032)低于延误组,90 d良好预后比率(66.7%比18.2%, P=0.008)高于延误组。二元logistic回归分...     

急诊绿色通道模式下溶栓治疗对轻中型急性缺血性脑卒中影响

目的 探讨急诊绿色通道模式下溶栓治疗对轻中型急性缺血性脑卒中的影响.方法 将北京老年医院自2020年1月至2021年1月收治的急诊绿色通道模式下接受溶栓治疗的55例轻中型急性缺血性脑卒中患者纳入B组,另将自2019年5月至2020年5月收治的传统急诊流程入院模式下接受溶栓治疗的54例轻中型急性缺血性脑卒中患者纳入A组....     

rt-PA动脉溶栓治疗急性脑梗死的疗效观察

目的分析动脉溶栓治疗急性脑梗死的安全性及疗效。方法对21例颈内动脉系统梗死患者(颈内动脉3例,大脑中动脉12例,大脑前动脉5例,豆纹动脉1例)进行rt-PA动脉溶栓治疗。治疗时间在发病后2～6h,观察术中血管再通及术后即刻、24h后分别行头颅CT或MRI扫描以明确有无颅内出血。术前及术后30d采用中国脑卒中神经功能缺损程度量表(chinese stroke scale)进行评估。结果21例患者动脉溶栓治疗中技术成功率100%。其中血管再通TMI分级2～3级16例,TMI分级0～1级5例。症状性脑出血3例,其中2例死亡。17例术后30d神经功能缺损评分减少>50%,2例<50%,死亡2例。TMI分级2～3级的血管再通患者生活状态明显优于TMI分级0～1级血管再通患者。结论急性脑梗死6h内动脉溶栓治疗比较合适,但也有并发脑出血的严重后果,开始溶栓时间越早越好。     

急性心肌梗死药物溶栓后早期介入治疗

目的　直接经皮冠状动脉腔内成形术 (PTCA)为急性心肌梗死 (AMI)提供了积极的有效的又安全的恢复心肌灌注的手段 ,优于常规溶栓治疗 ,但直接PTCA仍有时间延误问题。本研究旨在探讨AMI患者在等待PTCA时间延误期内 ,使用常规治疗剂量短效溶栓剂 (rt PA)治疗 ,促使梗死相关动脉(IRA)早期开通的有效性 ,及溶栓后立即进行加速PTCA可行性和安全性。方法　 75例AMI患者用阿司匹林和肝素后接受rt PA 2 0mg 1次团注 ,随后 80mg半小时内快速滴入 ,尽快行急诊冠状动脉造影术 ,对IRA行PTCA或支架植入术 ,如果血管开通 ,仍有残余狭窄 ,亦行PTCA及支架术 ,和同期进行 88例AMI直接PTCA进行对比分析。本试验终点包括 ,到达导管室血管开通率 ,PTCA的结果 ,治疗后导管室血管开通率 ,PTCA的结果 ,治疗后 2周内左室功能及不良事件发生率。结果　到达导管室时 ,联合治疗 (溶栓加PTCA)血管开通率 88% (2 6 %TIMIⅡ级 ,6 2 %TIMIⅢ级血流 ) ,直接PTCA组为 36 % (2 0 %为TIMIⅡ级血流 ,16 %TIMIⅢ级血流 ) (P <0 .0 0 1)两组PTCA血流再通率相似 ,分别为 96 %、94 %。对IRA恢复TIMIⅢ级血流效果相同 ,分别为 84 % ,82 %。 2周内左室功能 (超声法EF)联合治疗组优于PTCA组(6 5 .4 % ,5 4 .6 % ,P <0 .0 5 )两组住院期间不良事件发生     

Intravenous flat-detector CT angiography in acute ischemic stroke management

Introduction  

In the settings of stroke, a non-invasive high-resolution imaging modality to visualize the arterial intracranial circulation in the interventional lab is a helpful mean to plan the endovascular recanalization procedure. We report our initial experience with intravenously enhanced flat-detector CT (IV FDCT) technology in the detection of obstructed intracranial arteries.     

Intra-arterial thrombolysis for acute ischemic stroke

Intra-arterial thrombolysis is a maturing treatment for acute thromboembolic stroke that shows promise in restoring cerebral blood supply. Reviewed evidence suggests that intra-arterial treatment has a longer window for treatment than intravenous t-PA and does improve outcome. A favorable outcome is dependent on careful patient selection aimed at avoiding intracranial hemorrhage. This article describes features to evaluate for patient selection and highlights factors along the treatment algorithm to maximize success. Received: 19 June 2000 Accepted: 10 July 2000     

Treatment of acute ischemic stroke

Ischemic stroke is a medical emergency requiring fast and effective collaboration of neurologists and radiologists. Currently there are promising new developments in the treatment of acute ischemic stroke with efforts being made to reduce the door-to-needle time and to improve recanalization of occluded vessels by new endovascular techniques. Clinical trials have also demonstrated the efficacy of thrombolysis up to 4.5?h and confirmed the importance of the time to treatment for positive outcome.     

Imaging of acute ischemic stroke

For decades, imaging has been a critical component of the diagnostic evaluation and management of patients suspected of acute ischemic stroke (AIS). With each new advance in the treatment of AIS, the role of imaging has expanded in scope, sophistication, and importance in selecting patients who stand to benefit from potential therapies. Although the field of stroke imaging has been evolving for many years, there have been several major recent changes. Most notably, in late 2017, the window for treatment expanded to 24 h from onset of stroke symptoms in selected patients. Furthermore, for those patients in expanded time windows, guidelines issued in early 2018 now recommend the use of “advanced” imaging techniques in the acute setting, including CT perfusion and MRI, to guide therapeutic decision-making. With these and other changes, the emergency radiologist must be prepared to handle a growing volume and complexity of AIS imaging. This article reviews the various imaging modalities and techniques employed in the imaging of AIS patients, with an emphasis on recommendations from recent randomized controlled trials and national consensus guidelines.     

Advanced imaging application for acute ischemic stroke

With the approval of intravenous recombinant tissue plasminogen activator (r-TPA) in 1995, acute ischemic stroke therapy is increasingly being administered. Currently the approach to imaging these patients is very simplistic. Typically, noncontrast head computed tomography (CT) is the only study performed prior to treatment. Advanced imaging using CT or magnetic resonance imaging (MRI) can play a very important role in the triage and classification of patients with acute ischemic stroke. With knowledge of the location and size of the occlusion as well as the collateral circulation, the best treatment can be selected, minimizing any morbidity from treatment and maximizing the chance of success. The identification and stratification of patients according to their imaging and clinical features will further individualize treatment and allow tailored therapy. This review will discuss rapid imaging techniques that are easily available and the rationale for their use.     

急诊动脉内溶栓治疗急性缺血性脑梗死

目的 观察急诊动脉内溶栓（intra-arterial thrombolysis,IAT)治疗急性缺血性脑梗死的疗效及并发症，分析预后相关因素。方法 对25例发病在6h内的急性缺血性脑梗死患者行IAT治疗。血管再通程度根据“急性心肌梗死溶栓标准”（TIMI）分类。临床结果评价在溶栓后30d进行，根据改良的Rank分数（MRS）分为好结果（MRS0－3）、差结果（MRS4－6）两类。结果 溶栓前18例（72％）患者为TIMI0-1,7例（28％）为TIMI2。溶栓后13例（72％）患者部分／完全再通，5例（28％）未再通。18例患者（72％）为好结果，7例（28％）为差结果，其中4例死亡。发生症状性脑出血4例（16％）。结论 急诊动脉溶栓是可行安全的，溶栓前侧支循环、再通及溶栓后24h神经学检查上的提高（NI）与好结果密切相关，无再通与脑出血及死亡密切相关。提高动脉内溶栓临床效果的关键在于提高再通率。     

Clinical MRI of acute ischemic stroke

The most important service that imaging provides to patients with ischemic stroke is to rapidly identify those patients who are most likely to benefit from immediate treatment. This group includes patients who have severe neurological symptoms due to an occlusion of a major artery, and who are candidates for recanalization using intravenous thrombolysis or intra-arterial intervention to remove the occlusion. Outcomes for these patients are determined by symptom severity, the artery that is occluded, the size of the infarct at the time of presentation, and the effect of treatment. MRI provides key physiological information through MR angiography and diffusion MRI that has been proven to be of high clinical value in identify patients who are in need of immediate treatment. Perfusion MRI provides information about the ischemic penumbra, but its clinical value is unproven. In current clinical practice, the time since stroke onset is dominant over physiologic information provided by MRI in treatment decisions. This will change only when clinical trials prove that stroke physiology as revealed by MRI is superior to time from stroke onset in promoting good clinical outcomes.     

Computed tomography in acute ischemic stroke

Stroke remains the third most important cause of mortality in industrialized countries; this has prompted research for improvements in both diagnostic and therapeutic strategies for patients with signs of acute cerebral ischemia. Over the last decade, there has been a parallel in progress in techniques in both diagnostic and therapeutic options. While previously only used for excluding hemorrhage, imaging now has the possibility to detect ischemia, vascular occlusion, as well as detect tissue at risk in one setting. It should also allow to monitor treatment and predict/exclude therapeutic complications. Parallel to advances in magnetic resonance imaging of stroke, computed tomography has improved immensely over the last decade due to the development of CT scanners that are faster and that allow to acquire studies such as CT perfusion or CT angiography in a reliable way. CT can detect many signs that might help us detect impending signs of massive infarction, but we still lack the experience to use these alone to prevent a patient from benefitting from possible therapy.