对rt-PA治疗脑梗塞中颈动脉粥样硬化影响的再讨论

目的人体组织纤维蛋白溶解酶原酶(t-PA)治疗不同病因脑梗塞的疗效的再探讨。方法以颈动脉和心脏Doppler超声和数字式血管造影(DSA)的检查结果为依据作分组对比分析rt-PA的治疗效果。结果rT-PA治疗后24h症状改善与预后有关。颈动脉粥样硬化性完全梗塞和严重狭窄组病例溶栓起效时间明显推迟(P＜0.05)。3个月后颈动脉完全梗塞组68.75%有严重神经系统后遗症。结论颈动脉粥样硬化性梗塞和严重狭窄是影响溶栓治疗预后的一个重要因素。     

急性缺血性脑卒中治疗的成本效果评价

目的：比较应用溶栓、降纤和抗凝三种治疗急性缺血性脑卒中的成本效果。方法：283例CI病人根据治疗药物分为抗凝、降纤和溶栓组,溶栓组再根据溶栓方法分为静脉溶栓和动脉介入溶栓组。对四组病人进行NIHSS、ADL、QIL评分,同时调查治疗费用,治疗费用分为直接费用和间接费用。追踪时间为一年。结果：四种治疗方法不但影响费用而且影响治疗效果,进一步影响成本-效果比。结论：动脉介入溶栓治疗CI比内科治疗效果好,虽然手术费用高,但成本效果比好。     

重组组织型纤溶酶原激活剂静脉溶栓治疗急性心肌梗死的疗效及安全性分析

目的 分析研究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)的疗效及安全性.方法 对22例AMI患者进行rt-PA静脉溶栓治疗,先用15 mg静脉推注,0.75 mg/kg(最大量50 mg)静脉滴注30 min,0.5 mg/kg(最大量35 mg)静脉滴注60 min.观察溶栓后冠脉再通率、并发症的发生率、及住院期间的病死率.结果 本组冠脉再通率81.8%,出血发生率4.5%,住院期间的病死率4.5%,主要死因:心脏泵衰竭.结论 rt-PA急诊静脉溶栓治疗AMI是安全、有效的,可以有效地降低病死率.     

化痰通络方对急性脑梗死大鼠rt-PA溶栓后神经细胞自噬途径中Beclin1与LC3蛋白表达的影响

[目的]观察化痰通络方对急性脑梗死大鼠重组组织纤溶酶原激活剂(rt-PA)溶栓后神经细胞自噬途径中自噬相关蛋白(Beclin1)及微管相关蛋白轻链3(LC3)蛋白表达的影响。[方法]选择160只健康SD大鼠,随机分为假手术组、模型组、rt-PA组、化痰通络方联合rt-PA组(简称中药组),每组采用6 h、1 d、3 d和7 d 4个时相。采用自身栓子法制备大鼠大脑中动脉栓塞模型(MCAO),rt-PA组与中药组分别给予尾静脉注入rt-PA(浓度为5.67 mg/kg)及联合化痰通络中药(浓度为7.2 g/kg)干预,每日2次。于相应时间点采用Western blot检测各组大鼠大脑皮质梗死区组织中Beclin1及LC3蛋白的表达。[结果]Western blot结果显示:与假手术组相比,模型组在4个时相中Beclin1和LC3蛋白的相对丰度值均明显增高(P0.05);采用rt-PA和rt-PA联合化痰通络法干预后,4个时相内Beclin1与LC3蛋白的相对丰度值均明显下降(P0.05);且rt-PA联合化痰通络组下降更加显著,与rt-PA组比较差异有统计学意义(P0.05)。[结论]化痰通络方可通过降低神经细胞自噬途径中Beclin1与LC3蛋白的表达,部分抑制神经细胞的过度自噬,进而保护神经细胞损伤,从而更好的防治急性脑梗死溶栓后缺血再灌注的发生与发展。     

Complete Lysis of Left Ventricular Giant Thrombus with Fibrinolytic Therapy in Clopidogrel Resistant Patient

Sixty-year-old woman admitted with dyspnea and cough. Three weeks ago she underwent primary stenting for acute anterior myocardial infarction and recieved antiplatelet therapy (clopidogrel). Echocardiography and left ventriculography revealed left ventricular segmental dysfunction at anterolateral-apical region but no thrombus. On last admission, despite the clopidogrel therapy, echocardiography showed giant-partly mobil thrombus obliterated half of the left ventricle. Slow infusion of thrombolytic therapy was given and complete lysis occurred with uneventful course. Disclosure of such a rapidly evolving giant left ventricular thrombus in the clopidogrel non-responder is a rare clinical problem with potentially catastrophic consequences. Slow infusion of thrombolytic therapy may be effective and life saving.     

Efficacy of Thrombolytic (rt-PA) Therapy in Old Stroke Patients: The Perugia Stroke Unit Experience

The use of intravenous recombinant tissue plasminogen activator (rt-PA) administered within 3 hrs from symptom onset is beneficial in selected patients independent of age; although oldest patients (≥80 years) are excluded a priori. We report an experience relative to rt-PA treatment in the oldest patients including outcome at 3 months. Data were from the hospital-based Perugia Stroke Registry. Seventy-two consecutive acute stroke patients, fulfilling NINDS and EUSI-criteria were treated with rt-PA Of these 23 patients (30.5%) were ≥80 years. The median and mean age were, respectively, 72.5 and 71.1 ± 12.7 years (range 35–94). The proportion of favorable outcome at 3-months did not differ between groups (55% elderly versus 51.1% of younger patients). Proportions of unfavorable outcome and death from baseline were similar in both groups of patients. Age did not influence prognosis in patients treated with rt-PA. The oldest stroke patients should not be excluded from rt-PA treatment on the basis of age per se.     

Neuroprotection afforded by a combination of eliprodil and a thrombolytic agent, rt-PA, in a rat thromboembolic stroke model

In the present study, we have assessed the efficacy of eliprodil, a neuroprotective agent which blocks both the modulatory polyamine site of the NMDA receptor and neuronal voltage-sensitive calcium channels, alone or in combination with the thrombolytic agent, rt-PA, in a rat embolic stroke model using a neurological score and the volume of the infarct as endpoints. Embolization was induced by intracarotid injection of an arterial blood clot. Eliprodil, administered at the dose of 1 mg/kg, iv, 10 min and 2 h 30 after embolization, reduced the neurological deficit by 54% (P<0.01) and the total volume of the brain lesion by 49%. Thrombolysis with rt-PA (2.5 mg/kg, as a 30 min iv infusion beginning 1 h after embolization) decreased the neurological deficit by 48% (P<0.05) and the size of the total infarct by 55% (P<0.05). Combined therapy greatly improved the degree of neuroprotection as assessed by neurological and histological outcomes (70% (P<0.001) and 89% (P<0.01) neuroprotection, respectively). These results demonstrate that the administration of a neuroprotective drug (eliprodil) or a thrombolytic agent (rt-PA) similarly reduce the volume of brain damage and the neurological deficit in a rat embolic stroke model. Combined cytoprotective therapy and thrombolysis markedly improved the degree of neuroprotection and may, thus, represent a valuable approach for the treatment of stroke in humans.     

重组组织型纤溶酶原激活剂溶栓治疗的护理配合

急性缺血性脑卒中自然预后差,病死率和致残率高,及时的溶栓治疗能够再通堵塞血管,挽救缺血半暗带,被认为是最有希望治疗急性缺血性脑卒中的方法。重组组织型纤溶酶原激活剂（rt-PA）是惟一经循证医学证实能有效治疗发病3h内急性缺血性卒中的药物,本药的活性成分是一种糖蛋白,与纤维蛋白结合后可直接激活纤溶酶原转化为纤溶酶,导致纤维蛋白降解,血块溶解。     

不同方案治疗急性脑梗死伴意识障碍患者的对比研究

目的探讨rt-PA静脉溶栓和抗血小板聚集治疗急性脑梗死伴意识障碍患者的疗效和安全性。方法急性脑梗死伴意识障碍患者按照不同的治疗方案分为两组:抗血小板聚集组32例,口服拜阿司匹林0.3g/d;rt-PA静脉溶栓组24例,予rt-PA 0.9mg/Kg,最大剂量90mg。分别在治疗前和治疗后24小时和14、90天行NIHSS评分,90天行OHS评分,比较两组疗效;观察两组治疗后24小时和14、90d的死亡事件发生率和死亡原因;比较两组不同意识障碍程度患者14天的存活率。结果治疗后两组各时间点NIHSS评分和90天OHS评分rt-PA组较抗血小板聚集组下降,并且昏迷亚组14天存活率高于抗血小板聚集组,差异均有统计学意义(P<0.05);死亡事件发生率两组间差异无统计学意义(P>0.05)。结论 rt-PA静脉溶栓治疗重症急性脑梗死伴意识障碍患者安全、有效,可在临床推广应用。     

多模式CT指导动脉溶栓与静脉溶栓治疗急性脑梗死的对照研究

目的探讨多模式CT指导下的rt-PA动脉溶栓与静脉溶栓治疗急性脑梗死的安全性和有效性。方法收集颈内动脉系统急性脑梗死患者65例,随机分为动脉溶栓组35例和静脉溶栓组30例,记录溶栓前、溶栓后2、24h和7、30d的NIHSS评分及生活能力状态。溶栓30天后行疗效判定。结果动脉溶栓组平均NIHSS评分结果显著低于静脉溶栓组(P<0.05)。两组总显效率分别为74.29%和46.67%,动脉溶栓组优于静脉溶栓组(P<0.05)。结论多模式CT指导的动脉溶栓与静脉溶栓是治疗急性脑梗死安全、有效的方法,但前者临床疗效优于后者。