丁咯地尔治疗椎-基底动脉供血不足60例临床观察

目的观察丁咯地尔治疗椎-基底动脉供血不足的疗效。方法随机将126例椎-基底动脉供血不足患者分为治疗组60例，对照组66例。治疗组用丁咯地尔针150mg＋5％葡萄糖液250ml静脉滴注，每日1次；对照组给予刺五加针60mg＋5％葡萄糖液250m1静脉滴注，每日1次；两组均在治疗7天后观察疗效。结果治疗组总有效率明显高于对照组（P〈0．01）。结论丁咯地尔治疗椎-基底动脉供血不足疗效显著、安全，值得临床应用。     

步复迈治疗椎-基底动脉供血不足60例临床研究

椎-基底动脉供血不足(VBI)是中老年人常见疾病之一.我们采用步复迈(盐酸丁咯地尔氯化钠注射液)治疗VBI 60例,同时设对照组进行疗效观察,现总结如下.     

椎-基底动脉系统缺血发作及供血不足

1．什么是椎．基底动脉椎一基底动脉是脑的重要供血动脉。椎动脉左右各有一支，它穿行于颈椎两侧的横突孔，向上行进人头颅，二支血管在脑内合为一支叫基底动脉。从椎动脉和基底动脉又发出很多粗细不等的小血管，供应人脑的枕叶、小脑、脑干、丘脑及内耳等部位。椎动脉和基底动脉以及它们的分支统称为椎一基底动脉系统。     

椎基底动脉系统缺血性卒中的溶栓治疗

椎基底动脉系统缺血性卒中（VBIS）较少见,病情凶险,常规抗凝和降纤治疗预后差,病死率与致残率高。目前早期溶栓治疗急性颈内动脉系统缺血性卒中疗效最佳,而对VBIS采用溶栓治疗的经验不多。本文就VBIS溶栓治疗的时间窗、适应证、给药途径、疗效和并发症等作一综述。     

尿激酶溶栓治疗椎-基底动脉供血不足40例

椎-基底动脉供血不足（VBI）是最常见的缺血性脑血管病之一，是卒中发病的先兆，任其发展约有1／3的病人在以后数年内会发展为脑梗死，因此早期诊治甚为重要。我科应用小剂量尿激酶治疗VBI病人40例，疗效显著，现总结如下。     

心源性脑栓塞的溶栓治疗

在缺血性卒中的各亚型中，心源性脑栓塞（cardiogenic cerebral embolism，CCE）起病急骤，其脑梗死体积较大，神经功能损害通常较重，治疗棘手，预后较差。所谓CCE，是指由来自心脏的脱落栓子阻塞脑供血动脉，从而引起相应供血区脑组织的缺血性坏死，占整个缺血性卒中的20％。以往的治疗原则主要包括对症处理、治疗原发病和使用抗凝药，防止病情进展及再栓塞，但疗效欠佳。很多存活的患者出院时，仍遗留严重语言障碍和肢体瘫痪等。因此，CCE的治疗成为长期困扰临床医师而又亟需解决的问题。     

川芎嗪注射液治疗椎-基底动脉供血不足的疗效观察

目的观察与评估川芎嗪注射液治疗椎-基底动脉供血不足的疗效。方法将椎-基底动脉供血不足的患者随机分为治疗组（T组，45例）与对照组（N组，25例）。治疗组使用川芎嗪注射液100mg加入5％～10％葡萄糖注射液中静脉注射，每日1次，10天为1个疗程；对照组使用其他活血扩血管药物治疗，每日1次，10天为1个疗程。结果治疗组总有效率明显好于对照组，两组差异有显著性（P〈0．05）。结论川芎嗪注射液治疗椎-基底动脉供血不足的疗效显著。     

尼莫地平治疗椎-基底动脉缺血性眩晕30例疗效观察

椎-基底动脉缺血性眩晕是由于脑动脉硬化、颈椎病等原因导致椎-基底动脉系统供血障碍所致。多见于50岁以上的老年患者，临床表现为头位及体位变化引起的眩晕、视物旋转、恶心、呕吐。笔者从2002年3月-2006年7月应用尼奠地平治疗椎-基底动脉缺血性眩晕30例，疗效满意。现将临床资料报告如下。     

椎-基底动脉供血不足30例误诊分析

近3年来笔者收治曾被长期误诊为梅尼埃病的患者30例，均进行脑磁共振血管造影(脑MRA)检查。结果发现所有病例椎-基底动脉系统均显示有异常，按椎-基底动脉供血不足治疗，效果良好，现报告如下。     

通心络治疗椎-基底动脉供血不足临床观察

目的观察通心络胶囊治疗椎-基底动脉供血不足病人的临床疗效.方法椎-基底动脉供血不足病人60例,随机分为治疗组(通心络组)和对照组(脑络通组)各30例,用药14 d,分别观察两组治疗前后的临床疗效.结果治疗组总有效率为93.3%,对照组总有效率为66.7%,两组比较有统计学意义(P＜0.05).结论通心络治疗椎-基底动脉供血不足疗效明显,对脑血液循环有明显改善作用,且无毒副反应.     

Thrombolytic therapy for thromboembolism of vertebrobasilar artery

Thrombolytic therapy was carried out on four patients with brain stem stroke due to thromboembolism of the vertebrobasilar system. Diagnosis was confirmed by angiography. Clinical and instrumental findings indicated a very poor prognosis. Two of these patients were treated with urokinase and the other two with streptokinase for periods ranging from 16 to 44 hours. The interval between onset of symptoms and start of therapy was less than 10 hours for three of these patients. All made a gradual and almost complete recovery after only a few hours of treatment, and only one presented minimal residual neurological disability. The condition of the fourth patient, who started therapy four days after the first episode, remained unchanged until he died 16 hours later. Our observations suggest that thrombolytic therapy may be useful in treating recent acute life-threatening brain stem stroke.     

Thrombolytic therapy during acute myocardial infarction due to sudden occlusion of the left main coronary artery

Two patients who suffered from sudden occlusion of the left main coronary artery were successfully treated with intracoronary infusion of streptokinase. One of them underwent successful coronary bypass surgery and the other was treated with medical therapy only. The outcome of this highly lethal condition is discussed.     

椎基底动脉闭塞致急性脑卒中的血管内治疗

缺血性卒中占脑血管事件的86%,其中约20%发生在椎基底动脉系统。急性椎基底动脉闭塞(AVBAO)预后不佳,其死亡率可达80%~95%。由于常规的内科药物治疗预后较差,人们一直在探索动脉溶栓及其他血管内介入治疗等方法。椎基底动脉闭塞再通的患者更有可能获得良好的功能预后,因此近年来机械辅助溶栓,取栓、碎栓装置越来越多应用于临床。     

Thrombolytic therapy for central venous catheter occlusion

Background

Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal.

Design and Methods

This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms “central venous catheter”, “central venous access device” OR “central venous line” associated with the terms “obstruction”, “occlusion” OR “thrombolytic” was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed.

Results

Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67–74% within 30–40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16–68% in the control group to 4–23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group.

Conclusions

Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.     

Thrombolytic therapy of acute myocardial infarction

Thrombotic coronary artery occlusion is now recognized as the usual cause of acute myocardial infarction. The thrombus usually forms at the site of intimal disruption over an atherosclerotic plaque. Following coronary occlusion, myocardial necrosis begins within 40 minutes in the subendocardium and progresses outward toward the epicardium over the next several hours. The intracoronary infusion of streptokinase will produce lysis of the occluding thrombus in up to 80% of patients. It appears that reperfusion with streptokinase in the first few hours following the onset of the myocardial infarction produces a small increase in late left ventricular function, though ECG and enzyme evidence of acute myocardial infarction are not prevented. The improvement in left ventricular function is variable from patient to patient and has not been demonstrated in all the randomized studies to date. The time limit for myocardial salvage may not be the same in all patients. The greatest benefit is probably achieved with reperfusion in the first 4-6 hours, although some benefit may occur as late as 18 hours after the onset of infarction. Many patients who receive intracoronary infusion of streptokinase develop a systemic lytic state, though serious bleeding complications in carefully selected patients are infrequent. High-dose IV streptokinase is easier, cheaper, and quicker to initiate than intracoronary streptokinase but is probably less effective than the intracoronary route in producing rapid lysis of the occluding coronary thrombus. The optimal dose and rate of administration of IV streptokinase have not been determined. The final role and ultimate benefit of thrombolytic therapy of myocardial infarction have not yet been determined, but some of the issues may be clarified by the larger randomized trials now under way. It appears, at present, that the use of intracoronary streptokinase may have a role in the treatment of selected patients with acute myocardial infarctions in institutions with the facilities and the personnel necessary to perform this procedure safely. In the future, thrombolytic therapy may also have a place in the treatment of selected patients with unstable angina and post-myocardial infarction angina. The future availability of more selective thrombolytic agents may make the early IV therapy of myocardial infarction a safer, more effective option and expand the indications for thrombolytic therapy.     

急性缺血性卒中溶栓治疗

试验状态 :从 2 0 0 3年 10月开始 ,已经募集 3例患者。试验目的 :比较动脉内rtPA溶栓与静脉rtPA溶栓的疗效。试验设计 :多中心剂量开放随机对照试验 ,采用盲法随访。纳入标准 :大脑中动脉 (MCA)缺血性卒中发病 3h内的患者。排除标准 :卒中发病前已有残疾 ,发病时昏迷 ,神经功能缺损迅速改善 ,发病时出现癫 ,对比增强剂过敏 ,分娩期或哺乳期 ,未经控制的高血压 ,颅内出血 ,溶栓治疗的禁忌证或存在其他有可能增加患者危险的任何情况。患者处理 :患者随机分为静脉溶栓组和动脉内溶栓组 ,静脉溶栓组患者 (rtPA 0 9mg/kg ,最大剂量 90mg)…     

Thrombolytic therapy in acute venous thromboembolism

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