32例超急性期脑梗死患者超选择性动脉溶栓疗效分析

目的评价超选择性动脉溶栓治疗超急性期脑梗死的疗效及安全性。方法对32例发病3～18h的超急性期脑梗死患者行动脉内尿激酶(平均85×104u)溶栓,再通TIMI0的患者,辅以球囊扩张或血管内支架成形术,于1d、7d、14d、21d、30d行ESS评分。结果溶栓联合成形术后,12例血管再通TIMI3(37.5%),13例TIMI2(40.6%),6例TIMI1(18.8%),1例TIMI0(3.1%),总再通率96.9%。4例行球囊扩张或血管内支架成形术,3例TIMI3,1例TI-MI2。1例MCA和1例BA闭塞溶栓后4h内死于症状性颅内出血和循环呼吸衰竭,1例ICA并发分支栓塞,1例MCA并发ICA夹层。TIMI3、3、1三组均较治疗前有显著差异(P<0.05),TIMI3、2两组较TIMI1组疗效显著差异(P<0.05),TIMI3、2两组间无意义(P>0.05),仅1例BA闭塞再通TIMI0。结论超选择性动脉溶栓联合血管成形术是安全有效的治疗超急性期脑梗死的方法,可使大部分患者闭塞动脉迅速再通,提高临床疗效。但不宜过度强调理想再通,且须注意治疗个体化及并发症。

Analyzing curative effects of intra-artery selective thrombolytic therapy for 32 patients of acute ischemic cerebral infarction

Objective To evaluate the curative effects and security of intra-artery selective thrombolytic therapy for acute cerebral infarction(ACI).Methods 32 patients were treated with intra-arterial thrombolysis using urokinase(median dose,85×104u)within 3~18 hours after the ACI,and recanalization TIMI 0 cases were treated by PTA/Stenting,Followed up for 30d after the operation,the patients' condition was assessed by neurologists using european stroke scale(ESS).Results After thrombolysis and PTA/Stenting therapy for 32 cases,12 cases' recanalization was TIMI 3(37.5%),13 recanalization was TIMI 2(40.6%),6 recanalization was TIMI 1(18.8%),1 recanalization TIMI 0(3.1%),total recanalization rate was 96.9%.2 patients respectively died of symptomic intracranial hemorrhage(SIH)and circulation-respiratory failure(CRF).1 case was complicated by embolism and another generated dissection.All TIMI 1~3 groups ESS scores were significant deviation between pre-and post-thrombolysis(p<0.05),Clinical outcome of TIMI 2、3 groups was significantly better than TIMI 1 group(p<0.05),but between TIMI 3 and TIMI 2,there was no significant deviation(p>0.05),just one was TIMI 0.Conclusion Intra-arterial thrombolysis and PTA/Stenting is a safe and effective therapy method for acute ischemic cerebral infarction,with superiorities such as small dose,high blood concentration,good effectiveness etc.