急性脑梗塞动脉内溶栓治疗的临床疗效分析

目的 探讨急性脑梗塞动脉内溶栓治疗的临床疗效与影响因素。方法 288例脑梗死患者均在CT检查厦血管造影基础上接受选择性动脉溶栓治疗，其中在发病后6h以内溶栓者76例，6～24h溶栓者212例。统计两组患者的血管再通率和90天后预后情况。结果 脑血管造影发现血管闭塞245例，其中颈内动脉系统闭塞173例，椎基底动脉（VBA）闭塞72例；溶栓后再通分别为112例、38例。治疗后90天恢复良好者180倒，恢复差者108例。溶栓后颅内出血2例；6h内组和6～24h组患者治疗后90天预后良好率分别为80．35％和71．43％，血管再通率分别为67．86％和59．26％，血管再通中位时间分别为67min和73min。结论 局部动脉溶栓可以明显改善脑梗死患者的预后；仅以发病时间不超过6h作为动脉内溶栓治疗标准不够全面，应当根据病情适当放宽溶栓的时间窗。

Clinical analysis on acute cerebral infarction treated with intra- artrial thrombolytic therapy

Objective To study the clinical effects on acute cerebral infarction with local intra-arterial thrombolysis. Methods Two hundred and eighty eight patients with ischemic stroke were examined by CT and angiography received intra-arterial thombolytic therapy.Among the 288 patients, the period from stroke to thrombolysis less than 6 hours were 76 cases,and 212 cases were between 6 to 24 hours.The recanalization rate and clinical outcome were analyzed statistically. Results Angiography showed occlusion of the cerebral artery for 245 patients, among which the occlusion sites of 173 patients were found in the internal carotid artery (ICA) system and 72 occlusions in the vertebrobasilar artery(VBA), successful recanalization was achieved for 150 patients(112 patients in ICA and 38 patients in VBA).Followed up for 90 days, 180 patients recovered yet 108 had poor prognosis.Hemorrhage happened to two patients.The recanalization rate of two groups was 69.0 % and 50.0 % respectively, and the meso- time of revascularization was 67 and 73 minutes respectively.Conclusion Successful recanalization of cerebral occlusive artery by using intra-arterial thrombolysis could improve clinic prognosis in patients with acute ischemic stroke, and it is partial to limit therapeutic time window within 6 hours.Some cases with cerebral infarction after 6 hours of stroke onset can benefit from intra-arterial thrombolytic therapy.