尿激酶动脉内溶栓联合血管内干预治疗急性脑梗死分析

目的分析尿激酶动脉内溶栓联合血管内干预治疗急性脑梗死的疗效和安全性。方法回顾分析我科住院治疗13例患者进行尿激酶动脉内溶栓及血管内干预治疗的急性脑梗死患者临床资料。结果 13例患者中,颈动脉系统病变11例,其中颈内动脉闭塞2例,大脑中动脉主干及分支闭塞8例,大脑前动脉闭塞1例(包含脑血管造影未见异常者3例),椎基底动脉闭塞2例。溶栓开始时间3～12h,平均7.5h,其中10例在6h内开始。使用尿激酶30万～100万U,平均70万U。溶栓后2例给予血管内支架治疗,4例给予球囊扩张血管成形治疗。基本痊愈5例,显著进步5例,无效3例。闭塞血管成功再通7例,未成功再通3例。并发脑出血1例,死亡1例,无并发消化道出血等其他情况。结论对急性脑梗死患者进行尿激酶动脉内溶栓联合血管内干预治疗是安全有效的。

Assessment of the intra-arterial thrombolytic therapy of urokinase combined with intravascular intervention in the treatment of acute cerebral infarction

Objective To analysis of the efficacy and safety of the intra-arterial thrombolytic therapy of urokinase combined with intravascular intervention in the treatment of acute cerebral infarction.Methods Clinical data of the 13 patients who were diagnosed of acute cerebral infarction and received the intra-arterial thrombolytic therapy urokinase and intravascular intervention treatment in our branch,were analyzed retrospectively.Results Among the 13 patients,11 cases were carotid artery system lesions,including 2 cases of internal carotid artery occlusion,8 cases of middle cerebral artery trunk and branch occlusion,and 1 case of anterior cerebral artery occlusion(including 3 cases of cerebral angiography that showed no abnormalities),2 cases of vertebral basilar artery occlusion.The initiation time of thrombolysis was within 3 to12 hours,with an average of 7.5 hours.Ten cases began in 6 hours.300,000~1,000,000 U of urokinase was used,with an average of 700,000 U.After the thrombolytic therapy,two cases were given stands intravascular treatment.Four cases were given balloon dilatation angioplasty.Five cases were cured,5 cases were improved obviously and 3 cases were invalid.Seven cases of the occlusive vessels were opened successfully,and 3 cases were failed.One case happened cerebral hemorrhage.One patient died.There was no gastrointestinal bleeding,as well as other bleeding accidents.Conclusion It’s efficient and safe to apply the intra-arterial thrombolytic therapy urokinase combined with intravascular intervention in the treatment of acute cerebral infarction.