选择性动脉溶栓治疗急性大脑中动脉闭塞的体会

目的探讨选择性动脉溶栓治疗急性大脑中动脉闭塞的效果。方法对临床初诊急性大脑中动脉闭塞的患者,经全脑血管造影证实大脑中动脉闭塞并系责任血管后,取尿激酶50万IU稀释在50 ml生理盐水中,先在1 min内推注10万IU,再按1万IU/min泵入,每10 min造影一次。50 min泵完尿激酶,对再通者,停止溶栓;不全开通者再追加20万IU尿激酶;若血管还未开通或开通不理想,改用微导丝对血栓或栓子进行机械碎栓。结果采用选择性动脉溶栓与机械碎栓相结合的治疗方法,12例完全再通,8例部分再通,1例溶栓后再闭塞。2例血管完全开通后合并出血。16例患者临床症状得到改善,2例出现新的脑梗死灶。结论对于基层医院,采取选择性动脉溶栓和机械碎栓结合的方法救治急性大脑中动脉闭塞,疗效满意。

Experience of selective arterial thrombolysis treatment of acute middle cerebral arterial occlusion

Objective To investigate the method and result of selective artery thrombolysis treatment of acute middle cerebral arterial occlusion.Methods After preliminary diagnosis of acute middle cerebral artery occlusion confirmed by cerebral angiogram and which was responsibility for artery occlusion, take 500000 iu urokinase diluted in 50 ml normal saline.Inject 100,000 iu in one minute first and pump the rest part in 10,000 iu/min,and take image every 10 minutes until finishing the rest of urokinase in 50 minutes.Stop thrombolysis if recanalization, or add another 200000 iu.Finally, when the recanalization of vessel was not seen or not ideal, use micro-guide wire for mechanical thrombolysis.Result With selective artery thrombolysis combined with mechanical thrombolysis, 12 cases were completely recanalization, 8 cases were partly recanalization, 1 case occlusion, and 2 cases were hemorrhagic after recanalization.There were 16 cases of patients with clinical symptoms improving, 2 cases of new infarction lesions observed.Conclusion In primary hospitals, with selective artery thrombolysis combined with mechanical thrombolysis, the effect was satisfactory.