静脉溶栓治疗急性缺血性脑卒中治疗时间窗的研究

目的旨在探讨静脉溶栓治疗急性缺血性脑卒中的最佳治疗时间窗。方法采用静脉输注尿激酶进行前瞻性随机对照的临床试验。按发病距治疗的时间将入选的２５例病人分为治疗组（发病距治疗时间＜４小时）和对照组（发病距治疗时间４～１２小时）。以欧洲脑卒中神经功能缺损计分（ＴｈｅＥｕｒｏ ｐｅａｎＳｔｒｏｋｅＳｃａｌｅ）为标准，对照比较两组病人的起效时间、总体疗效、疗后转归及安全范围。结果治疗组起效时间（１５～１８０分钟）较对照组（２．３～２８小时）显著缩短。疗后一个月神经功能缺损计分，治疗组较对照组有显著的改善（Ｐ＜０．０５）。对照组溶栓后发生皮下和齿龈出血２例。治疗组无１例并发症发生。结论静脉溶栓治疗急性缺血性脑卒中是早期开通闭塞脑血管的有效和理想的方法。最佳的治疗时机（时间窗）应当选择在发病后的４小时以内。

Study on Treatment Time Window for Intravenous Thrombolysis of Acute Ischemic Stroke

Objective To determine the most optional treatment time window for intravenous thrombolysis of acute ischemic stroke.Method The randomized prospective and the same class controlled clinical trial were studied.25 cases were divided into treatment group(<4h) and control group(4～12h) according to admmision time.The neurological deficit was determined based on The European Stroke Scale.The onset of stroke,total efficacy,prognosis and safety range were controlled.Results Time of effect begining of treatment group was significantly shorter than that of control group(15～180min Vs 2.3～28 hours,P<0.05).The evaluation of the neurological scale after one month of treatment showed that the former was significantly improved than that of the latter.2 cases of bleeding were found in control group and no complication was seen in treatment group.Conclusions Intravenous thrombolysis in acute ischemic stroke is an effective,optimal method to deoppilate occluded cerebral vessels,the most optional time of treatment(treatment time window) may be within 4 hours from onset of stroke.