阿替普酶治疗不同时间窗发病急性脑梗死疗效观察

目的观察不同剂量阿替谱酶(rt-PA)治疗不同时间窗发病急性脑梗死的疗效观察。方法选择2019年1月至12月于发病<4.5 h行rt-PA静脉溶栓治疗的急性脑梗死患者122例,对其资料进行回顾性分析。按照发病时间窗、rt-PA剂量不同分为4组,发病至用药时间<3 h为Ⅰ组,rt-PA剂量0.6mg/kg(Ⅰa组),0.9 mg/kg(Ⅰb组);发病至用药3~4.5 h为Ⅱ组,rt-PA剂量0.6 mg/kg(Ⅱa组),0.9 mg/kg(Ⅱb组)。比较4组患者间溶栓治疗后2h、24 h、7 d神经功能缺损量表(NIHSS)评分改善情况。结果Ⅰa组与Ⅱa组比较,溶栓后2h、24h、7d NIIHSS改善程度较后者明显(P<0.05);Ⅰb组与Ⅱb组比较,溶栓后2 h NIHSS改善程度较后者明显(P<0.05)。Ⅰ组与型组比较,2h、24 h、7 d症状程度明显改善(P<0.05)。结论超早期应用rt-PA,治疗时间窗越短,早期疗效越佳。     

酒后脑梗死的溶栓治疗

目的探讨酒后脑梗死患者的特点、溶栓决策及结局。方法选取2012年9月~2013年6月期间首都医科大学附属北京天坛医院神经内科急诊溶栓绿色通道的酒后脑梗死患者11例,收集患者的临床表现、影像特征、溶栓情况及结局进行回顾性分析。结果 11例酒后脑梗死患者发病0.5~8 h进入急诊溶栓绿色通道,皆为男性,中位数年龄59岁(四分位数间距53.5~60),到达医院时平均中位数发病时间为120 min(四分位数间距45~250)。就诊时主要症状:9例为偏身无力,1例为偏身不自主运动,1例为单肢麻木。小卒中患者8例(73%)。临床过程及转归:2例接受静脉溶栓后明显改善,1例接受动脉溶栓后明显改善,2例拒绝溶栓后自发缓解,3例因症状轻微而未溶栓且自发缓解,2例发病超过3 h的患者因磁共振灌注成像正常而未溶栓,1例发病超过3 h的患者因磁共振弥散加权成像和灌注成像均正常而未溶栓。最终5例在影像上有明确的新发梗死灶。根据急性卒中治疗低分子肝素试验病因分型法(Trial of Org 10172 in Acute Stroke Treatment,TOAST)的分型标准,接受溶栓的3例患者中,2例为大动脉粥样硬化性闭塞,1例为小动脉闭塞;拒绝和未接受溶栓的8例患者均为小动脉闭塞。结论酒后脑梗死多数预后好,有可能从溶栓中获益。酒后脑梗死病因多为小动脉闭塞,少部分是大动脉粥样硬化性闭塞。     

Impact of Oral Thrombolysis After Catheter-based Thrombectomy in Acute and Subacute Submassive Pulmonary Thromboembolism

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Safety and Efficacy of Low Dosage of Urokinase for Catheter-directed Thrombolysis of Deep Venous Thrombosis

Background:

Catheter-directed thrombolysis (CDT) has been a mainstay in treating deep venous thrombosis (DVT). However, the optimal dosage of a thrombolytic agent is still controversial. The goal of this study was to evaluate the safety and efficacy of low dosage urokinase with CDT for DVT.

Methods:

A retrospective analysis was performed using data from a total of 427 patients with DVT treated with CDT in our single center between July 2009 and December 2012. Early efficacy of thrombolysis was assessed with a thrombus score based on daily venography. The therapeutic safety was evaluated by adverse events. A venography or duplex ultrasound was performed to assess the outcome at 6 months, 1 year and 2 years postoperatively.

Results:

The mean total dose of 3.34 (standard deviation [SD] 1.38) million units of urokinase was administered during a mean of 5.18 (SD 2.28) days. Prior to discharge, Grade III (complete lysis) was achieved in 154 (36%) patients; Grade II (50–99% lysis) in 222 (52%); and Grade I (50% lysis) in 51 (12%). The major complications included one intracranial hemorrhage, one hematochezia, five gross hematuria, and one pulmonary embolism. Moreover, no death occurred in the study.

Conclusions:

Treatment of low-dose catheter-directed thrombosis is an efficacious and safe therapeutic approach in patients with DVT offering good long-term outcomes and minimal complications.     

Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention

Objectives

The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery.

肠系膜静脉血栓形成的临床特点分析

目的分析急性肠系膜静脉血栓(acute mesenteric venous thrombosis,AMVT)和慢性肠系膜静脉血栓(chronic mesenteric venous thrombosis,CMVT)的临床特点。方法对首都医科大学附属友谊医院1980年10月至2005年12月确诊的33例肠系膜静脉血栓(MVT)患者的临床资料进行了分析,并结合文献,总结MVT的临床特点和治疗方法。结果33例MVT中,慢性肠系膜静脉血栓11例,年龄32~78岁(平均46.6岁),无急腹症的表现,均是在腹部CT检查中发现肠系膜静脉血栓;另22例为AMVT患者,年龄19~75岁(平均48.9岁)。主要症状和体征为腹痛、腹胀、腹部膨隆、腹膜刺激征,呕吐68.2%(15/22),发热36.4%(8/22)。误诊率59.1%(13/22),手术治疗17例,死亡7例,治愈10例;溶栓治疗5例痊愈。结论早期腹部CT结合肠系膜上动脉造影可对早期AMVT做出正确的诊断,早期溶栓或手术治疗可以降低病死率。     

尿激酶溶栓治疗脑血栓40例疗效评估报道

目的：对脑血栓治疗中尿激酶溶栓疗法起到的临床作用进行分析探讨。方法选取2012年7月～2014年12月同期于我院进行脑血栓治疗的患者40例,将其分为实验组和对照组。对对照组患者给予低分子肝素进行治疗,对实验组患者给予尿激酶进行溶栓治疗。治疗结束之后对两组患者的治理效果及缺损评分进行比较。结果实验组的总体有效率为80.00%较对照组的60.00%具有优势,实验组缺损评分低于对照组,数据具有统计学差异（P＜0.05）。结论对脑血栓患者采取尿激酶进行溶栓治疗能有效治愈患者疾病。     

Simple mechanical thrombectomy with intrapulmonary arterial thrombolysis in pulmonary thromboembolism: a small case series

Pulmonary thromboembolism （PTE） is a life-threatening condition with a high early mortality rate caused by acute right ventricular failure and cardiogenic shock. We report a series of three patients who presented with acute and subacute submassive PTE. They were suc-cessfully treated by simple catheter-based mechanical thrombectomy and intrapulmonary arterial thrombolysis. Mechanical fragmentation and aspiration of thrombus was performed by commonly used J-wire, multi-purpose and Judkin Right guiding catheters and this obviated the need of specific thrombectomy devices.     

Correlates and Outcomes of Late and Very Late Drug-Eluting Stent Thrombosis: Results From DESERT (International Drug-Eluting Stent Event Registry of Thrombosis)

ObjectivesThe aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events.BackgroundLate/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies.MethodsIn the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs.ResultsThe majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non–ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios <2.5).ConclusionsDespite a large sample of ST cases and use of limited matching to maximize the identification of predictive factors associated with late/very late ST, the variables associated with the development of late/very late ST were only weakly predictive of subsequent events. Additionally, a relatively low observed mortality rate of ST in this series may reflect a different pathophysiology of these late/very late events compared with acute/subacute ST. (Drug Eluting Stent Registry of Thrombosis [DESERT]; NCT00812552).