Assessment of reperfusion following thrombolysis with mean fibrillation and amplitude spectrum area in patients with sustained ventricular fibrillation

Background: Improved microcirculatory reperfusion in patients with ventricular fibrillation (VF) enhances the electrical activity of the fibrillation process and increases the likelihood of successful defibrillation.

Methods: Changes in amplitude spectrum area (AMSA) and mean fibrillation (MF) in patients with sustained VF were analysed after administration of rt-PA variant tenecteplase in out-of-hospital cardiac arrest (OHCA) during cardiopulmonary resuscitation (CPR).

Results: A total of 69 ECG sequences from nine patients were evaluated. Patients who received tenecteplase showed significantly longer duration of VF (p?=?0.016). While AMSA declined significantly during CPR (p?=?0.001), MF did not differ between groups. There were two survivors in the treatment group and one in the control group.

Conclusion: When tenecteplase was administered during CPR, VF lasted significantly longer than in controls. Changes in MF and AMSA did not indicate improved myocardial perfusion in patients who received tenecteplase during CPR.     

52例急性缺血性脑卒中静脉溶栓临床观察

目的:探讨静脉溶栓治疗急性缺血性脑卒中的临床效果及应用价值。方法:回顾性分析52例急性缺血性脑卒中患者的一般资料,按照随机、对照的原则分为观察组和对照组各26例。对照组在经头部CT和凝血功能检查后,采用常规治疗方法。观察组在对照组治疗基础上,立即采用尿激酶静脉溶栓治疗。观察和比较两组临床治疗效果及治疗过程中不良反应的发生情况。结果:观察组临床治疗总有效率为92.3%,对照组临床治疗总有效率为65.4%,差异具有统计学意义(P<0.05);观察组在治疗过程中出现1例牙龈出血,对照组在治疗过程中出现8例患者注射部位局部皮下瘀斑,观察组不良反应率明显低于对照组,差异显著(P<0.05)。结论:尿激酶静脉溶栓治疗急性缺血性脑卒中的临床效果显著,不良反应低,能够明显改善患者的病情和预后,提高患者的生存质量和生活质量,值得临床进一步推广应用。     

多模式CT下行溶栓时强化降压治疗对CIS患者的疗效评估

目的探讨多模式电子计算机断层扫描(Computed tomography,CT)下行溶栓时强化降压治疗对缺血性脑卒中(cerebral Ischemic stroke,CIS)患者的疗效及预后价值。方法选取2017年2月至2019年3月于我院进行多模式CT下溶栓治疗的CIS患者201例,随机数字表法分为对照组(100例)、观察组(101例),对照组患者行标准化降压干预,观察组患者行强化降压手段干预。比较两组患者血压、血液流变学水平,评价两组患者神经功能、日常生活能力。比较两组治疗有效率及预后情况。结果溶栓后观察组患者收缩压、舒张压、高切黏度、低切黏度、血浆比黏度、红细胞比容均低于对照组(P0.05);观察组患者NDS评分低于对照组,barthel评分高于对照组,治疗总有效率高于对照组,预后情况优于对照组(P0.05)。结论在多模式CT下行溶栓时对患者进行强化降压干预,能够改善患者血液流变学情况,有着较好的预后效果。     

血管内支架成形术治疗脑动脉闭塞的临床研究(附38例报告)

目的观察动脉内超选择性溶栓或/和血管内支架成形术治疗急性或进展性缺血性脑梗死的疗效及并发症。方法采用随机对照方法,将38例因粥样硬化所致急性或进展性脑血管栓塞病例,分为治疗组21例(选择性脑动脉内接触溶栓辅以血管内支架成形术)和对照组17例(单纯选择性脑动脉内接触溶栓),进行疗效及并发症等方面的对比研究。结果治疗组治疗急性或进展性缺血性脑梗死,其血管再通率、神经功能缺损评分降低程度、临床预后均优于对照组;治疗后血管再狭窄、再闭塞率低于对照组;症状性出血率高于对照组。结论选择性脑动脉内接触溶栓结合血管内支架成形术治疗急性或进展性缺血性脑梗死,是一积极、有效、相对安全的方法。     

尿激酶静脉溶栓联用低分子肝素治疗急性心肌梗死临床研究

目的:了解尿激酶静脉溶栓联用低分子肝素治疗急性心肌梗死(AMI)的临床效果。方法:符合溶栓条件的急性心肌梗死病例50例,应用尿激酶与低分子肝素治疗,并与同期收治的70例未溶栓急性心肌梗死患者进行比较。结果:治疗10d后溶栓再通组临床心功能改善程度及射血分数明显优于未溶栓组(p<0.01)。结论:尿激酶静脉溶栓联用低分子肝素治疗急性心肌梗死安全、有效,应用较方便。     

急性心肌梗死静脉溶栓治疗后ST段再抬高临床意义探讨

目的:探讨急性心肌梗死(AMI)静脉溶栓治疗中ST段再抬高产生的原因及临床意义。方法:回顾性分析符合静脉溶栓标准的121例AMI患者的临床资料,据溶栓后有无ST段再抬高而分为ST段抬高组(A组)和ST段未抬高组(B组),比较两组间血管再通率、心律失常发生率、CK峰值水平、梗死后心绞痛、猝死发生率及心功能变化、冠脉造影结果。结果:A、B两组患者各项指标均有显著性差异(P<0.05)。A组血管再通率明显低于B组(P<0.05);梗死后心律失常发生率、心绞痛发生率、猝死率及心功能不全发生率均高于B组(P<0.05);A组伴发代谢综合征明显多于B组(P<0.05)。结论:静脉溶栓治疗时ST段再抬高与患者合并代谢综合征有密切关系。在溶栓后1~2h内出现ST段下降后再抬高或原有梗死相关部位ST段抬高再加重,其原因可能与溶栓后再灌注损伤及冠脉痉挛有关,其它部位ST段抬高,可能与溶栓后纤溶激活状态致冠脉痉挛或闭塞有关。而在24h后出现ST段再抬高可能与新的血栓形成引起再闭塞或梗死延展有关。     

Treatment of subclavian-axillary vein thrombosis: long-term outcome of anticoagulation versus systemic thrombolysis

Objective: To investigate long-term clinical and morphological outcome of patients with subclavian–axillary vein thrombosis treated with systemic thrombolysis compared to anticoagulation in a retrospective, nonrandomised study. Methods: We studied 95 consecutive inpatients with subclavian–axillary vein thrombosis treated either with systemic urokinase thrombolysis and subsequent oral anticoagulation (n=33) or with anticoagulation only (n=62). Anticoagulation was performed with heparin and phenprocoumon. Patients were followed for median 40 months (IQR 14 to 94) for symptomatic upper extremity post-thrombotic syndrome and for venous recanalisation by duplex ultrasound. Results: Primary technical success rate of the systemic thrombolysis was 88% (n=29) with seven peri-intervention bleeding complications (21%). No complication was observed in patients with anticoagulation only (p<0.0001). At the time of follow-up, duplex sonography showed a thrombotic subclavian vein in 40 of 83 patients (48%), but only 9 of 95 patients (10%) had a symptomatic upper extremity post-thrombotic syndrome. Patients with systemic thrombolysis exhibited a 60% adjusted reduced risk for a thrombotic subclavian vein at the time of follow-up compared to patients with anticoagulation only (95% CI: 0.2 to 0.9, p=0.03). However, the frequency of symptomatic post-thrombotic syndrome after thrombolysis and anticoagulation was similar (adjusted p=0.6). Conclusion: Systemic thrombolysis of subclavian–axillary vein thrombosis has an acceptable primary technical success rate and improves venous recanalisation rates compared to anticoagulation. However, the high rate of complications during thrombolysis and the lack of clinical benefit suggest that conservative treatment may be favoured.     

重组人组织型纤溶酶原激活剂缺失变体对犬冠状动脉血栓的溶栓作用

目的观察重组人组织型纤溶酶原激活剂缺失变体(reteplase)对犬冠状动脉血栓的溶栓作用。方法实验用杂种犬,设溶剂对照组r、eteplase 100×104、50×104和25×104IU/kg 4组。手术分离冠状动脉左旋支(LCX),以血管内膜粗糙 电刺激法形成冠状动脉左旋支血栓,检测静脉注射不同剂量reteplase后对冠状动脉左旋支血流量、栓塞再通率、心肌梗死范围、伤口失血量和末梢出血时间的影响。结果静脉注射reteplase可使栓塞的冠状动脉血管很快出现再通,血流量显著增加,心肌梗塞范围明显缩小,明显增加伤口出血量,延长末梢出血时间,rete-plase各剂量组与溶剂对照组比较均有显著差别(P<0.001)。结论reteplase对犬冠状动脉血栓具有显著的溶栓作用。     

急性心肌梗死溶栓后检测肌红蛋白、肌钙蛋白I、肌酸激酶同工酶对冠脉再通的诊断价值

目的探讨血清肌红蛋白(Mb)、肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)对急性心肌梗死溶栓冠脉再通的早期诊断价值。方法应用酶联免疫分析法测定106例急性心肌梗死患者溶栓治疗后Mb、cTnI、CK-MB浓度的变化,分析急性心肌梗死患者溶栓再通组(73例)和溶栓未通组(33例)上述指标的变化。结果急性心肌梗死溶栓再通组Mb、cTnI和CK-MB达到峰值浓度的时间较未通组明显提前(P<0.05),其中Mb较cTnI、CK-MB峰值出现更早,分别为(5.9±2.5)h、(14.5±3.2)h和(14.8±3.9)h(P<0.01);Mb、cTnI和CK-MB对判断冠脉再通的敏感性、特异性、预测值无显著性差异(P>0.05)。结论血清Mb、cTnI和CK-MB可以较好地预测急性心肌梗死患者溶栓再通,其中Mb较cTnI、CK-MB能更早的判定冠状动脉是否再灌注。     

Temporary Vena Cava Filters and Ultrahigh Streptokinase Thrombolysis Therapy: A Clinical Study

Purpose: To assess the efficacy of temporary vena cava filters in patients undergoing ultrahigh-dose streptokinase thrombolysis for iliocaval thrombosis and to determine therapy success and filter and therapy complications. Methods: Forty-five patients were studied regarding extension and characteristics of thrombosis, duration, success, and complications of thrombolysis therapy, filter type, access route, pulmonary embolisms, and filter complications. Results: Complete recanalization was achieved in 57% of cases. Filters were inserted predominantly via a transbrachial route. One fatal pulmonary embolism (2%) occurred 1 day after starting thrombolysis. No other pulmonary embolism was noted. Other complications were induced by thrombolysis alone (n = 12), thrombolysis and filter (n = 9), and filter alone (n = 11). Conclusion: Fatal pulmonary embolisms as a complication of ultrahigh-dose treatment of pelvic or caval thrombosis can not safely be prevented by the temporary vena cava filters currently available. Filter design needs to be improved.