尿激酶双重溶栓联合机械性碎栓治疗急性脑梗死患者的护理

目的探讨尿激酶双重溶栓治疗急性脑梗死患者的安全可行性及护理。方法对发病6h以内的9例急性脑梗死患者（研究组），用90万U尿激酶溶于100ml生理盐水中静脉滴注，同时行3DDSA检查确定梗死的脑动脉及溶栓部位，采用微导丝机帻陛碎栓及小剂量尿激酶颅内动脉溶栓；同期治疗的16例（对照组）用120万U尿激酶溶于120ml生理盐水中静脉滴注。结果研究组中基本治愈6例，显效1例，有效2例，无效0例，显效率为77．8％，总有效率为100％；对照组分别为2，1，5，8例，显效率为18．75％，总有效率为50％。显效率和总有效率两组相比，差异有统计学意义（P〈Q05）。研究组术后欧洲脑卒中评分法（ESS）（77．50±0．71）分，对照组为（62．25±5．95）分，两组比较差异有统计学意义（P〈0.05）。结论6h以内的急性脑梗死患者，采用双重溶栓联合机械性碎栓，能使闭塞的动脉尽陕开通，安全有效，是一种可行的治疗方式。护理组建立绿色通道，积极为溶栓争取时间，并严密观察病睛变化，做好溶栓患者的护理，可取得较好疗效。

Nursing of intracranial arterial recanalization in patients with acute infarction by urokinase intravasal thrombolysis double interventional therapy

Objective To explore the feasibility and safety of urokinase intravasal thrombolysis double interventional therapy in patients with acute infarction. Methods 9 patients with acute cerebral infarction within 6h were in study group, 900 000 units of urokinase dissolved into 100 ml saline was used as intravenous drip for these patients, meanwhile, 3D DSA examination conducted to confirm cerebral artery of infarction and the position of thrombus, then mechanical thrombolysis by micro-guiding-wire and thrombolysis by small dose urokinase were done. 1 200 000 units of urokinase dissolved in 120 ml saline was used as intravenous drip in control group (16cases). Results 6 cases were generally cured, 1 case got marked effect, 2 cases were effective, 0 cases was inefficient, the rate of marked effect was 77. 8%, total effective rate was 100%;Corresponding results in control group were 2,1,5,8, rate of marked effect was 18.75%, total effective rate was 50%; the differences of marked effect rate and total effective rate in two groups were statistically significant( P ＜0.05). ESS score was (77.50 ±0.71) in study group and (62.25 ±5.95) in control group, the differences between two groups were statistically significant ( P ＜ 0. 05 ). Conclusions Urokinase intravasal thrombolysis double interventional therapy is safety and effective and can recanalize occlusive artery as soon an possible for acute cerebral infarction patients within 6 hours, it's a kind of feasible therapy. Nurse should establish green channel, strive time for thrombolysis, observe patient' condition closely and give appropriate nurse, then better curative effect can be achieved.