急性缺血性脑卒中的溶栓治疗

Intravenous thrombolysis for acute ischemic stroke

急性缺血性脑卒中最有效的治疗是再灌注治疗(溶栓、机械取栓或支架术等)。在可挽救的缺血脑组织进展梗死以前通过恢复其血流量,再灌注治疗可挽救缺血半暗带组织、减少最后梗死面积、改善临床结果。重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓是目前惟一一种证实有效的治疗急性缺血性脑卒中的药物。虽然溶栓治疗日趋成熟,但标准的静脉溶栓治疗(非增强计算机断层扫描(CT)引导下、3h内、静脉注射tPA,)有许多限制,包括治疗时间窗短、血管再通率只有50%和症状性出血转变的重大危险等。结果,目前在临床实践中只有少数患者(通常是1%至3%)接受溶栓治疗。所以有一些问题仍需进一步探讨,如扩大溶栓时间窗、新的溶栓药物用于发病3h以上的急性缺血性脑卒中患者、评价各种新的再灌注方法(特别是多模式影像学技术)、静脉和动脉内药物溶栓联合应用、溶栓和新型抗小板药的联合应用,以及应用机械装置或经颅多普勒超声促进药物溶栓的作用等。

Smnmary： Reperfusion therapies （ thrombolysis, mechanical thrombeetomy, or stenting, etc. ） for acute ischemic stroke are the most effective therapy. Reperfusion therapy may limit ischemic tissue enlargement,leading to a reduced infarct size and favorable clinical outcome by restoring the blood flow before the salvageable penumbra became the progress of ischemie brain infarction, intravenous （ IV ） recombinant tissue plasminogen activator （rt-PA） therapy is the only proven effective treatment of acute ischemie stroke. Although thrombolytic therapy has matured,but the standard intravenous thrombolytic therapy （nonenhanced computed tomography （CT）-guided, 3 h time window, the intravenous injection of tPA） have many restrictions, including a short therapeutic time window, recanalization rate was only 50 %, and the major dangers of symptomatic hemorrhagic transformation. As a result, currently in clinical practice, only a minority of patients （usually 1% to 3% ） received thrombolytic therapy. So there are some issues still need to be further explored, such as the expansion of thrombolytic time window, a new thrombolytic drugs are used for more than 3h incidence of acute ischemic stroke patients, the evaluation of new reperfusion methods （in particular, multi-modal imaging technology）, intravenous, and intra-arterial thrombolysis combined application of thrombolytic therapy, and new anti-platelet drug combination, and the application of mechanical devices or by transcranial Doppler ultrasound to promote the role of thrombolytic drugs.