动脉溶栓和动静脉联合溶栓及机械取栓治疗急性脑梗死的比较研究

目的评价动脉溶栓、动静脉联合溶栓和单纯机械取栓治疗急性脑梗死的疗效及安全性。方法选择急性脑梗死颅内血管狭窄或闭塞患者61例,根据不同溶栓方法分动脉溶栓组25例,动静脉联合溶栓组(联合溶栓组)17例,单纯机械取栓组(机械取栓组)19例。分别对治疗前后患者的美国国立卫生研究院卒中量表(NIHSS)评分、治疗的有效性、近期与远期疗效进行分析。结果与治疗前比较,动脉溶栓组、联合溶栓组治疗后2周NIHSS评分明显降低(P<0.05,P<0.01),机械取栓组治疗后3d、2周NIHSS评分明显降低(P<0.05,P<0.01)。动脉溶栓组残余狭窄率≤30%发生率、急性血管再闭塞率和病死率分别为16.0%、52.0%和12.0%,联合溶栓组分别为11.8%、52.9%和0,机械取栓组分别为47.4%、0和10.5%。3组残余狭窄率≤30%发生率、急性血管再闭塞率比较,差异有统计学意义(P<0.05,P<0.01)。结论不论采用动脉溶栓、动静脉联合溶栓还是机械取栓方法,均可使患者神经功能改善,对近期临床预后的改善有相近效果。采用机械取栓方法对神经功能改善时间较早、溶栓效果、安全性及远期临床预后较好。     

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.     

急性脑梗死患者早期溶栓治疗的临床观察及护理体会

目的探讨急性脑梗死患者早期溶栓治疗的临床观察及护理体会。方法选取我院2011年6月—2013年6月收治的40例急性脑梗死患者,按照随机数字表将其分为治疗组和对照组,各20例。两组患者均给予溶栓治疗,对照组患者给予常规护理,治疗组在常规护理的基础上给予临床观察及护理干预措施。结果治疗组总有效率为90%,高于对照组的75%,差异有统计学意义(P<0.05)。结论病情观察及合理的护理对急性脑梗死患者早期溶栓治疗的成功具有重要的临床意义,值得推广应用。     

急性脑梗死溶栓治疗的研究进展

急性脑梗死的溶栓治疗一直是研究热点,美国国立神经疾病与卒中研究所试验的公布使脑梗死的溶栓治疗有了突破性进展.越来越多的研究开始致力于探索更多的溶栓方案.文章就溶栓治疗的丰要方法、药物和近几年的研究进展做了综述.     

活血化瘀汤对动脉溶栓后急性脑梗死患者的治疗作用

将20例发病6 h以内、行动脉内超选择性尿激酶溶栓治疗的急性脑梗死患者随机分成两组,治疗组在溶栓前及溶栓后给予中药活血化瘀汤口服,对照组不服中药汤剂.比较两组术前及术后24 h、48 h、30 d卒中量表评分及临床疗效.结果 治疗组溶栓后血管再通率为80%,对照组为70%,两组间无统计学差异;治疗后48 h两组疗效有统计学差异(P＜0.05),30 d时更加明显(P＜0.01),两组均无死亡病例.认为活血化瘀汤对介入性动脉溶栓疗效有协同作用,安全有效.     

低频超声联合静脉溶栓治疗急性脑梗死临床疗效观察

目的观察低频超声联合静脉溶栓治疗急性脑梗死的疗效及安全性。方法选取2015年6月~2016年12月聊城市脑科医院神经内科收治的急性脑梗死患者94例,按照随机数字表法将患者分为观察组与对照组,各47例。对照组患者给予阿替普酶注射剂静脉溶栓治疗,观察组在对照组治疗基础上联合应用低频超声治疗。比较2组美国国立卫生研究院卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分,并记录2组不良反应发生情况。结果观察组治疗总有效率高于对照组(95.7%vs 80.9%,P=0.025)。治疗后2组患者NIHSS评分均较治疗前有所改善(P0.05),观察组治疗后7和14dNIHSS评分均显著低于对照组(2分vs 4分,P0.05;1分vs 2分,P=0.03)。2组治疗后14和90dmRS评分与治疗前比较有显著差异(P0.05),且观察组mRS评分显著低于对照组(P0.05)。观察组与对照组不良反应发生率差异无统计学意义(44.68%vs 42.55%,P0.05)。结论低频超声联合静脉溶栓治疗能更好的提高溶栓效果,改善急性脑梗死患者症状,且未增加不良反应的发生。     

急性脑梗死溶栓治疗的新模式

对急性脑梗死患者闭塞血管的及时开通会显著降低患者的致残率和病死率，故时间就是大脑。近20年来，学者们一直探索应用各种技术，以实现这一设想，同时也在科学地评估各种治疗方法的风险和获益。     

尿激酶静脉溶栓联合尤瑞克林治疗急性脑梗死的临床疗效研究

目的观察尿激酶静脉溶栓联合尤瑞克林治疗急性脑梗死的疗效及用药安全性。方法将我院收治的急性脑梗死患者182例,依据用药方式的差异予以分组,其中对照组90例仅给予尤瑞克林治疗,试验组92例给予尿激酶静脉溶栓联合尤瑞克林治疗,比较两组的疗效及不良反应。结果用药后试验组美国国立卫生研究院卒中量表(NIHSS)评分低于对照组;试验组总有效率为84.8%,高于对照组的70.0%,差异有统计学意义(P<0.05)。两组患者不良反应经对症处理后均恢复正常。结论尿激酶静脉溶栓联合尤瑞克林治疗急性脑梗死,在恢复和保护患者神经元功能及疗效方面,均较单用尤瑞克林佳,且安全可靠。     

动脉内接触性溶栓治疗急性脑梗死研究现状

溶栓治疗急性脑梗死仍处于探索阶段。文章就动脉内接触性溶栓的理论根据、治疗时间窗、操作方法、临床疗效以及溶栓后辅以颅内动脉血管成形术等作了综述。     

老年患者急性心肌梗死的溶栓治疗

本文探讨了老年急性心肌梗死患者溶栓治疗的新观点,较详细地介绍了老年患者链激酶及速效组织型纤溶酶原激活剂的各项结果分析。     

Rescue percutaneous coronary intervention for failed thrombolysis.

BACKGROUND: Previous studies of rescue percutaneous coronary intervention (PCI) for failed thrombolysis yielded conflicting results. In the current era of newer thrombolytic agents, coronary stents, glycoprotein IIb/IIIa inhibitors, and aggressive hemodynamic support, the outcome of this high-risk patient group has not been characterized. METHODS: From January 2000 to October 2004, 214 consecutive patients were transferred and underwent emergent coronary angiography following failed thrombolysis. One hundred and fifty five (72%) underwent immediate PCI, 23 (11%) underwent delayed PCI, and 36 (17%) received surgical revascularization or medical therapy. Medical records and angiograms for the entire PCI cohort (n=178) were reviewed for in-hospital events including bleeding complications, stroke, recurrent ischemia or myocardial infarction (MI), target vessel revascularization (TVR), and death. RESULTS: Time from symptom onset to thrombolysis (mean +/- standard deviation) was 5.6 +/- 11.9 hr, and time from thrombolysis to angiography was 7.0 +/- 5.5 hr. The study cohort was critically ill, with 9.6% experiencing cardiac arrest, 21% in cardiogenic shock, and 12% intubated prior to transfer. Coronary stents were placed in 88%, Rheolytic thrombectomy was used in 21%, an intraaortic balloon pump was placed in 17%, and a glycoprotein IIb/IIIa inhibitor was administered in 92%. Patients receiving delayed PCI had higher TIMI 3 flow grade at initial angiography than those receiving immediate PCI (83% vs. 34%, respectively, P < 0.0001). Angiographic success was 90% for the entire PCI cohort, 89% for the immediate PCI group, and 100% for the delayed PCI group. Clinical success (angiographic success and freedom from major adverse cardiac events) was 85% for the entire PCI cohort, 83% for the immediate PCI group, and 100% for the delayed PCI group. Severe and moderate bleeding complications occurred in 7.3%, stroke in 1.7%, recurrent ischemia or MI in 7.3%, and TVR in 3.4%. Overall, in-hospital mortality for the entire PCI cohort was 3.4%. CONCLUSIONS: This observational, consecutive, real-world study of contemporary rescue PCI for failed thrombolysis shows a high use of coronary stents, Rheolytic thrombectomy, glycoprotein IIb/IIIa inhibitors, and intraaortic balloon pump placement. Angiographic and clinical success was high with low bleeding complications and low in-hospital mortality, suggesting that prospective, randomized trials using contemporary interventional therapy for rescue PCI be considered.     

老年急性心肌梗死患者溶栓后补救性冠状动脉介入治疗的临床研究

目的　评价老年急性ST段抬高性心肌梗死患者,在急诊静脉溶栓治疗后,对于梗死相关冠状动脉未能有效开通的病例,进行补救性冠状动脉介入治疗。方法　≥70岁急性ST段抬高的心肌梗死(ST segmentelevationacutemyocardialinfarction ,STE AMI)患者5 2例(≥70岁组) ,在急诊静脉溶栓治疗后若判定梗死相关动脉未能有效开通,则即行冠状动脉造影,若造影显示梗死相关动脉血流为非TIMI 3级灌注、同时患者仍有较明显胸痛和(或)梗死对应心电图导联ST段抬高,并除外急诊冠状动脉介入治疗的禁忌证,即进行梗死相关冠状动脉的补救性介入治疗(包括球囊扩张、支架置入)。同时与<70岁的6 7例(<70岁组)STE AMI患者进行比较。结果　与<70岁组患者比较,≥70岁组的STE AMI患者在进行了静脉溶栓治疗后行急诊冠状动脉造影显示:溶栓有效开通比例低,同时在心肌梗死急性期的死亡绝对数较大;但梗死相关动脉经皮冠状动脉介入治疗(PCI)成功比例两组无差异,同时,在≥70岁组,接受了静脉溶栓治疗后,再行PCI的严重出血并发症(包括颅内出血、消化道大出血等)并未见增加。结论　≥70岁组患者静脉溶栓有效开通比例较低,进行补救性PCI成功比例与<70岁组的STE AMI患者相同,在严密监测出、凝血参数情况下出现严重出血并发症低。     

高龄脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓的有效性和安全性

目的探讨高龄脑梗死患者应用重组组织型纤溶酶原激活剂(rt -PA)静脉溶栓治疗的有效性和安全性。方法选择急性脑梗死患者196例,根据患者年龄分为<80岁组141例和≥80岁组55例,发病<4.5 h的患者给予rt-PA静脉溶栓治疗,比较2组患者溶栓前、溶栓后14 d的美国国立卫生研究院卒中量表(NIHSS)评分,观察溶栓后颅内出血(ICH)和症状性颅内出血(sICH)的发生率。90 d随访时,采用改良Rankin's评分评定临床结局。结果 2组溶栓后14 d的NIHSS评分都较溶栓前显著降低(P<0.01),<80岁组较≥80岁组NIHSS评分降低更明显(P<0.01)。≥80岁组的病死率显著高于<80岁组(P<0.05);<80岁组和≥80岁组预后良好的比例分别为57.5%和45.5%(P>0.05),ICH发生率分别为16.3%和21.8%,sICH发生率分别为6.4%和14.5%(P>0.05)。结论高龄脑梗死患者应用rt-PA静脉溶栓和年龄<80岁者同样是安全有效的。     

急性心肌梗死患者溶栓后血浆中脑钠素浓度变化的研究

目的研究血中脑钠素(BNP)水平与急性心肌梗死溶栓后左心室射血分数(LVEF)和心肌缺血程度的关系。方法将198例顺序入选的急性心肌梗死行链激酶静脉溶栓治疗的患者分为溶栓成功组(105例)和溶栓未成功组(93例),检测所有患者的血BNP水平及测定LVEF,比较溶栓成功组与溶栓未成功组LVEF>40%和LVEF≤40%的BNP水平。结果溶栓成功组BNP水平明显低于溶栓未成功组的BNP水平(725.4±169.8)ng/L(P<0.05),溶栓成功组和未成功组中LVEF>40%患者的BNP水平[(107.7±46.5)ng/L,(488.5±88.9)ng/L]明显低于LVEF≤40%患者的BNP水平[(515.5±121.2)ng/L,(856.7±129.5)ng/L,P<0.01]。结论急性心肌梗死患者血中BNP水平与LVEF和心肌缺血程度有关。     

重组组织型纤溶酶原激活剂联合尿激酶治疗急性脑梗死的临床观察

目的观察低剂量重组组织型纤溶酶原激活剂(rt-PA)联合尿激酶静脉溶栓治疗急性脑梗死的远期疗效和安全性。方法选择急性脑梗死患者161例,分为4组:联合溶栓组44例,给予静脉rt-PA尿激酶;rt-PA组37例,尿激酶组32例,对照组48例。观察治疗前及治疗后90 d美国国立卫生研究所卒中量表(NIHSS)评分,同时观察再梗死率、脑出血率及病死率。结果与治疗前比较,4组治疗后90 d NIHSS评分差异均有统计学意义(P<0.01)。3个溶栓组与对照组在90 d有效率及疗效满意率差异均有统计学意义(P<0.01);3个溶栓组90 d有效率及疗效满意率差异无统计学意义(P>0.05)。联合溶栓组与rt-PA组和尿激酶组脑出血率比较差异均有统计学意义(2.3%υs 18.9%υs 18.7%,P<0.05)。结论 rt-PA联合尿激酶治疗急性脑梗死远期疗效和单用rt-PA、单用尿激酶相当,但脑出血率降低,因此该治疗方法是安全有效的,值得推广应用。     

急性脑梗死溶栓治疗的磁共振成像研究

目的探讨MRI对急性脑梗死溶栓后血管再通和梗死灶变化的评价。方法32例大脑前循环阻塞的急性脑梗死患者,其中20例行动脉内溶栓治疗(溶栓组),12例保守治疗(保守组)。治疗前后行MR常规T1加权成像、T2加权成像检查和磁共振血管成像(MRA)以及治疗前弥散加权成像、灌注加权成像检查。比较治疗前后MRA显示的血管再通和梗死灶变化情况。结果治疗前,MRA显示78%(25/32)血管阻塞。治疗后,溶栓组MRA显示72%(13/18)血管早期再通,而保守组中29%血管再通;两组有显著性差异(P=0.0279)。血管再通的病灶增加较小,与血管未通者比较差异有显著性意义(P<0.05)。结论MRI有助于急性脑梗死治疗后血管早期再通的显示及临床治疗效果的评价。     

Outcome of different reperfusion strategies in patients with former contraindications to thrombolytic therapy: A comparison of primary angioplasty and tissue plasminogen activator

High-risk patients have been excluded from most thrombolytic trials because of concern over hemorrhagic complications or lack of efficacy. However, based on several recent studies suggesting that patients with relative thrombolytic contraindications may also benefit from reperfusion, recommendations have been made to broadly expand the eligibility criteria for thrombolytic therapy, despite higher absolute complication rates. Primary percutaneous transluminal coronary angioplasty (PTCA) may be an attractive alternative for patients presenting at appropriately equipped hospitals who would otherwise remain at high risk after thrombolytic therapy. In the Primary Angioplasty in Myocardial Infarction (PAMI) trial, 395 patients with acute myocardial infarction were randomized to tissue plasminogen activator (t-PA) or primary PTCA. Conditions were present In 151 patients (38%) which formerly would have contraindicated thrombolytic therapy (age >70 yr, symptom duration >4 hr, or prior bypass surgery). In-hospitality was 4.3-fold higher in patients with former thrombolytic contraindications compared to lytic-eligible patients (8.6% vs. 2.0%, P = .002). Lytic-eligible patients treated with t-PA and PTCA had similar in-hospital mortality (1.7% vs. 2.4%, P = NS). In contrast, both in-hospital (2.9% vs. 13.2%, P = .025) and 6-mo mortality (2.9% vs. 15.7%, P = .009) were significantly reduced in patients with former thrombolytic contraindications treated by primary PTCA compared to t-PA. By logistic regression analysis, treatment by PTCA rather than t-PA was the strongest predictor of survival in patients with former thrombolytic contraindications. We conclude that patients with conditions formerly contraindicating thrombolytic therapy constitute a high-risk group with significant morbidity and mortality after lytic reperfusion. Our data suggest that patients with former contraindications to thrombolytic therapy may benefit by preferential management with primary PTCA without antecedent thrombolysis. © 1996 Wiley-Liss, Inc.     

溶栓治疗老年人弥漫性严重冠脉病变的临床观察

目的观察尿激酶（UK）联合华发林治疗弥漫性严重冠脉病变的疗效及安全性。方法选择48例内科常规治疗包括硝酸酯、钙离子拮抗剂、β受体阻滞剂及低分子肝素等效果不佳的弥漫性严重冠脉病变患者,应用UK3.36.7 mkat（1 mkat=6×104U）加入生理盐水100 ml中,于30 min内输完,每日1次,连续应用710 d,然后口服华法林,观察心绞痛的发生频率及程度、心电图ST段及心功能的变化。结果经过此种治疗方法与治疗前相比较,心绞痛的发生频率及程度减轻,心电图ST段及心功能改善。结论UK溶栓联合华发林抗凝治疗可使内科常规治疗效果不佳的弥漫性严重冠脉病变患者的心绞痛得到缓解。     

经局部动脉内溶栓治疗急性脑梗死

目的　研究经血管内选择性溶栓治疗 49例 8h内发病的急性脑梗死患者 ,以评估动脉内溶栓治疗急性脑梗死的疗效。方法　患者均急诊行头颅CT检查 ,31例经股动脉插管 ,全脑血管造影确认脑梗死 ,再选择性将导管插入患侧颈内动脉和椎动脉并注入尿激酶 5 0～ 75万单位行接触性和区域性溶栓治疗。对照组 18例行常规治疗。结果　溶栓后血管再通率为 71% ,有效率为 83%。 2 3例颈内动脉系和 4例椎基动脉系梗死在溶栓后 2周内神经损害体征明显改善 ,2例死亡。溶栓组改良爱丁堡 斯堪的纳维亚脑卒中量表 (MESSS)评分改善 (2 1.6± 13.6 )分 ;对照组改善 (5 .9± 5 .3)分。溶栓组发病时间越短其疗效越好。结论　选择性动脉内溶栓治疗是一种治疗急性脑梗死的有效方法 ,具有较高的血管再通率