急性脑梗死患者的局部动脉溶栓治疗

目的观察局部注射尿激酶动脉溶栓治疗急性脑梗死的疗效及并发症。方法对48例发病于6 h内的急性脑梗死患者行动脉内超选择性尿激酶溶栓治疗。其中颈内动脉主干闭塞5例(10.4%),大脑中动脉主干及分支闭塞36例(75.0%),大脑前动脉闭塞4例(8.3%),椎基底动脉闭塞3例(6.3%)。结果经溶解血栓治疗后完全再通28例(58.3%),部分再通11例(22.9%),未通9例(18.8%);溶解血栓治疗后3个月疗效良好的患者33例,疗效差者15例;39例溶通患者中疗效良好者31例(79.5%),9例未溶通患者中疗效良好者2例(22.2%);溶栓后脑出血11例(22.9%)。结论局部动脉溶栓治疗能明显提高血管再通率,明显改善预后,是治疗急性脑梗死的一种有效的方法。

Local intra-arterial thrombolysis in acute cerebral infarction

Objective To observe the efficacy and complication of local intra-arterial thrombolysis（LIT） using urokinase in patients with acute cerebral infarction.Methods 48 patients with acute cerebral infarction within 6h from onset were treated with intra-arterial thrombolysis using urokinase.The locations of occlusion included of 5 internal carotid artery（ICA）,36 of middle cerebral artery（MCA）,4 of anterior cerebral artery（ACA） and 3 of the posterior circulation.Results Complete recanalization after thrombolysis were observed in 28 of the 48 patients（58.3%）,partial recanalization in 11 of the 48 patients（22.9%）,no recanalization in 9 of the 48 patients（18.8%）.The clinical outcome 3 months after thrombolysis was evaluated according to MRS score.33 patients were good outcome（MRS score ≤ 2） and 15 patients were poor outcome（MRS score ≥ 3）.39 of the 48 patients（79.5%） of complete/partial recanalization were good outcome,only 2 of the 9 patients（22.2%） of no recanalization were good outcome.Cerebral hemorrhages occurred in 11 patients（22.9%） after thrombolysis.Conclusion LIT using urokinase can apparently improve the rate of recanalization and clinical outcome.It is an effective and relatively safe therapy in the treatment of acute cerebral infarction.