急性脑梗死超早期重组组织型纤溶酶原激活物溶栓治疗的临床研究

目的:探讨发病6h内急性脑梗死给予重组组织型纤溶酶原激活物(rt-PA)溶栓治疗的疗效及并发症,并分析预后相关因素。方法:共收集本院2001-2005年70例溶栓治疗的急性脑梗死病例,其中52例静脉溶栓,18例动脉溶栓,分析比较两组病例溶栓前后及3个月随访的ESS评分及Barthel指数结果;同时分析与预后相关的因素。结果:静脉和动脉溶栓组溶栓前及溶栓30min后ESS评分及Barthel指数迅速增加,溶栓前后分值有显著差异。1个月内颅内出血率为5.77%(静脉组)和16.67%(动脉组)。3个月时ESS评分及Barthel指数较溶栓后30min的评分有显著改善。结论:6h内动脉、静脉溶栓治疗均安全有效。     

Coagulation alterations due to local fibrinolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) in patients with peripheral arterial occlusive disease

Purpose To determine the systemic effects of local fibrinolytic therapy with low-dose recombinant tissue-type plasminogen activator (rt-PA). Methods Ten patients received intrathrombal infusion of 20 mg rt-PA and heparin for local thrombolysis and had subsequent percutaneous transluminal angioplasty (PTA). Eight controls underwent PTA and received heparin alone. We measured t-PA, D-Dimer, and fibrinogen levels before, directly after, and 20, 40, and 60 min and 24 hr after therapy. Results In the thrombolysis group the t-PA level peaked immediately after infusion and then declined within 1 hr. D-Dimer increased and remained elevated, whereas in the control group only t-PA levels increased, and only after 24 hr. Fibrinogen remained within the normal range in both groups. Eight of ten patients in the thrombolysis group and seven of eight with PTA had clinical improvement after the procedure. Conclusions The increase in D-Dimer in the rt-PA group indicates a good local fibrinolytic effect. The fact that fibrinogen levels remained unchanged indicates that there is a lack of systemic fibrinogenolysis.     

Efficacy and tolerance of recombinant tissue-type plasminogen activator in patients with thrombotic or embolic occlusions of leg-arteries

Summary The efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA) was evaluated in 46 patients with thrombembolic arterial occlusions in leg arteries. rt-PA was given over 1–4 h with a maximum dose of 18 mg. The effect of rt-PA treatment was determined as patency of the occluded arteries in 44 different patients 14 days after treatment. In 41 patients at least one artery was recanalized (93%) by rt-PA, and in almost half of these patients (48%) no residual stenosis were detected after the lytic treatment. A slight residual stenosis was detected in 29% of the patients and a severe residual stenosis in 21%. An additional treatment with percutaneous transluminal angioplasty was performed in 23 of the 44 patients and successful in 21 (91%). In 8 patients an addition catheter-embolectomy was performed. No difference in patency rate was detected between patients with thrombotic and those with embolic occlusions. The age of the occlusion influenced the patency rate; occlusions under the age of 5 weeks showed a patency rate of 96% compared to 82% in older occlusions. The length of the occlusion did not have any influence on the outcome of the rt-PA treatment. From the results of this open study we conclude that a dose of up to 18 mg of rt-PA is both safe and effective in the treatment of thromboembolic occlusions in leg arteries.Abbreviations rt-PA recombinant tissue-type plasminogen activator - GGT gamma-glutamyltransferase - SGOT aspartate aminotransferase - SGPT alanine aminotransferase - LDH lactate dehydrogenase - PTA percutaneous transluminal angioplasty Dedicated to Prof. Dr. N. Zöllner on the occasion of his 70th birthday     

rt-PA溶栓治疗急性心肌梗塞临床观察

组织型纤溶酶原激活剂 (rt- PA)是人体血液中存在的两种纤溶酶原激活剂之一 ,既往是从黑色瘤培养液中提取 ,产量低 ,现已采用基因重组技术生产 ,称为重组组织型纤溶酶原激活剂 (即 rt- PA)。利用 rt- PA静脉溶栓治疗急性心肌梗塞 ,取得较好临床疗效 ,现报告如下。1　资料与方法1.1　对象　本组病例收集于 1999年 1月至 2 0 0 0年 1月在心内科住院患者 2 2例。所有病例根据病史、心电图、心肌酶测定确诊为急性心肌梗塞 ,年龄 31～ 72岁 ,平均年龄 6 1岁 ;男性19例 ,女性 3例 ;体重 >5 0 kg者 18例 ,<5 0 kg者 4例。所有病例均符合 1996年…     

Full colour reproduction of figures originally submitted in colour

Case reports on three patients who underwent vitrectomy assisted t-PA injection for the management of branch retinal vein occlusion. Three-port, 20-gauge vitrectomy was performed under local anesthesia. After posterior vitreous detachment and fluid-air exchange, 50 μ g t-PA/0.5 ml were injected in the eye. All patients were instructed for strict supine position for 6 hours. Main outcome measure was visual acuity. Three patients with branch vein occlusion (BVO) were studied, with duration of symptoms less than 25 days, and mean follow-up period of 18.8 months. Although no intraoperative complications were noticed, no one showed any significant improvement of vision. One patient required a second operation for the management of intravitreal hemorrhage, and another developed an epiretinal membrane. Vitrectomy assisted t-PA injection does not seem to improve the course of branch retinal vein occlusion in this small case series. Future research on intravitreal thrombolysis needs to be focused on additional mechanical approaches and modalities that can facilitate the access of the drug into the vascular lumen.     

不同年龄急性缺血性脑卒中患者阿替普酶静脉溶栓的风险获益分析

目的： 探讨不同年龄段急性缺血性脑卒中患者静脉溶栓治疗的安全性和有效性。方法： 回顾性收集扬州市江都人民医院2017年7月至2020年3月神经内科收治的静脉溶栓患者共126例作为研究对象。按照患者年龄分为4组（<60岁,60~69岁,70~79岁,≥ 80岁）,患者发病时间均小于4.5 h,采用阿替普酶静脉溶栓治疗,并通过χ²检验比较患者溶栓前的一般资料,根据溶栓前后美国国立卫生研究院卒中量表（NIH stroke scale,NIHSS）评分改善情况进行有效性分析,患者出血情况及其他不良反应进行安全性分析。结果： （1）年龄≥ 80岁组患者房颤比例较高,Toast分型中（cardio embolism,CE）型比例较高,与其他组有显著差异。其余基线资料无统计学差异。（2）4组患者NIHSS评分降低无显著差异,24 h恢复良好率、NIHSS评分改善情况无显著差异;（3）4组患者出血发生率、非直接不良反应发生率、出院死亡率无显著差异;年龄≥ 80岁组患者颅内出血风险显著增加。结论： 对于发病4.5 h的高龄（≥ 80岁）急性缺血性卒中患者,静脉溶栓治疗获益与<80岁患者相同,出血风险也并未增加,但是对于年龄超过80岁且伴有房颤患者,NIHSS评分较高时,选择是否溶栓要慎重。     

重组组织型纤溶酶原激活剂动脉溶栓联合血管内治疗对早期急性脑梗死的疗效观察

目的 探析重组组织型纤溶酶原激活剂（rt-PA）动脉溶栓联合血管内治疗发病时间6 h内急性脑梗死（ACI）的临床疗效。方法 选取2017年2月—2019年3月徐州医科大学第二附属医院收治的发病<6?h ACI患者160例,按照患者及家属对治疗方案的选择意愿分组,观察组采取rt-PA+血管内支架成形术治疗,对照组采取rt-PA动脉溶栓,每组80例。比较两组术前、术后24?h、7?d、3个月NIHSS评分、ADL评分,观察患者血管再通情况,记录不良反应及临床预后。结果 两组不同时间点的NIHSS评分和ADL评分有差异（P?<0.05）,两组的NIHSS评分和ADL评分有差异（P?<0.05）,两组的NIHSS评分和ADL评分变化趋势有差异（P?<0.05）。观察组血管再通率为100%（完全再通76例,部分再通5例）,对照组血管再通率为95%（完全再通62例,部分再通14例,未通4例）,两组血管再通率比较差异有统计学意义（P?<0.05）。观察组术后仅2例再发脑梗死,未出现死亡病例,对照组术后12例再发脑梗死,且4例因脑梗死伴脑疝死亡,两组预后比较差异有统计学意义（P?<0.05）。结论 ACI发病6?h内采取rt-PA联合血管内支架成形术治疗可提高溶栓效果,促进神经功能恢复,改善预后,安全性良好。但受血管内介入治疗技术及术前准备耗时等因素的影响,可能会延长溶栓处理时间,抵消早期动脉溶栓的优势,建议视患者病情制订个体化溶栓治疗方案。     

Lower dosage of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of acute pulmonary embolism: A systematic review and meta-analysis

Background and Objective

According to US Food and Drugs Administration (FDA), 2 hour recombinant tissue plasminogen activator (rt-PA) 100 mg infusion is recommended for eligible patients with acute pulmonary embolism (PE). However,there exists evidence implying that a lower dosage of rt-PA can be equally effective but potentially safer compared with rt-PA 100 mg regimen. The aim of this systematic review and meta-analysis is to assess the efficacy and safety of low dose rt-PA in the treatment of acute PE.

Material and Method

We searched Pubmed, EMBASE, the Cochrane library and CBM Literature Database for randomized controlled trials (RCT) focusing on low dose rt-PA for acute PE. Outcomes were described in terms of changes of image tests and echocardiography, major bleeding events, all-cause death, and recurrence of PE.

Results

Five studies (440 patients) were included, three of which compared low dose rt-PA (0.6 mg/kg, maximum 50 mg or 50 mg infusion 2 h) with standard dose (100 mg infusion 2 h). There were more major bleeding events in standard dose rt-PA group than in low dose group (OR 0.33, 95%CI 0.12-0.91;P = 0.94,I² = 0%), while there were no statistical differences in recurrent PE or all cause mortality between these two groups. Two studies compared low dose (0.6 mg/kg, maximum 50 mg/2 min bolus or 10 mg bolus, ≤ 40 mg/2 h) with heparin. There was no significant difference in major bleeding events (OR 0.73, 95% CI 0.14-3.98;P = 0.72), recurrent PE or all cause mortality. No dose-related heterogeneity was found for all the included studies.

Conclusions

The results of this meta-analysis were hypothesis-generating. Based on the limited data, our systematic review suggested that low dose rt-PA had similar efficacy but was safer than standard dose of rt-PA. In addition, compared with heparin, low dose rt-PA didn’t increase the risk of major bleeding for eligible PE patients.     

急性肺栓塞二次溶栓治疗的疗效及安全性评价

目的 评价急性肺栓塞二次溶栓治疗的疗效及安全性.方法 回顾分析2002年7月～2010年10月在我院住院的12例需溶栓的急性肺栓塞病人,予重组组织型纤溶酶原激活剂(rt-PA)50 mg静脉输注,24小时后复查CT肺动脉造影(CTPA)、心脏超声,血栓部分溶解且心脏超声示右心室室壁运动功能异常,再次予重组组织型纤溶酶原激活剂40mg静脉输注行二次溶栓治疗.结果 有效率100％.1例病人出现生殖道出血,无颅脑出血等危及生命的不良反应.结论 急性肺栓塞首次予重组组织型纤溶酶原激活剂50 mg静脉溶栓,血栓部分溶解且心脏超声示右心室室壁运动功能异常者二次溶栓疗效确切,安全性好.