急性脑梗塞动脉内溶栓治疗时间窗选择与疗效分析

目的探讨急性脑梗塞动脉内溶栓治疗时间及梗塞部位等因素对疗效的影响。方法288例脑梗塞患者均在CT检查及血管造影基础上接受选择性动脉溶栓治疗,其中在6h以内溶栓者76例,6~24h溶栓者212例。统计2组患者的血管再通率和90d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90d恢复良好者180例,预后差108例。颅内出血2例。不同治疗时间2组患者治疗后90d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68min和73min。结论动脉溶栓治疗脑梗塞,动脉内溶栓时间窗与多种因素密切相关。

Analysis of Therapeutic Time Window and Effect in 288 Cases of Acute Cerebral Infarction Treated with Intra- arterial Thrombolytic Therapy

Objective To analyze the beginning time of treatment and the different region of infarction on the therapeutic effect of local intra-arterial thrombolysis in acute cerebral infarction.Methods 288 patients with ischemic stroke examined by CT and angiography were received intra-arterial thrombolytic therapy,of them,the thrombolytic therapy was done within 6 h in 76 cases and at 6~24 h in 212 cases after onset of stroke.The recanalization rate and clinical prognosis were statisticed in two groups 90 days later.Results The occlusion of the cerebral artery was showed on angiography in 245 cases including internal carotid artery(ICA) system in 173 and vertebrobasilar artery(VBA) in 72 cases.The successful recanalization was achieved in 150 cases (ICA in 112 cases and VBA in 38 cases).90 day later,180 cases obtained a good outcome and 108 had poor prognosis . 2 patients associated with hemorrhage . The recanalization rate of two groups was 67.86% and 59.26% respectively,the reperfusion time of occluded artery was 68 and 73 minutes respectively.Conclusion In treating acute cerebral infarction using intra-arterial thrombolysis,the therapeutic time window is closely related to a lot of factors.