超选择脑动脉内溶栓治疗急性脑梗塞

Treatment of Actute Cerebral Infarction with Superselective Intra-arterial Thrombolysis

目的 观察超选择脑动脉内溶栓治疗急性脑梗塞的疗效。方法70例脑梗塞患者,随机分为治疗组(40例)和对照组(30例)。治疗组采用超选择脑动脉内溶栓方法,起病距溶栓时间3～12h。尿激酶以1.5-2万U/min持续泵入,总量为50～90万U。两组患者的其它常规辅助治疗相同,治疗14d后评价其临床疗效。结果治疗组总有效率90.0％(36/40),显著优于对照组的70.0％(21/30),两组比较有显著差异(P<0.05)。治疗14d后治疗组神经功能缺损评分显著降低,显著优于对照组(P<0.01)。结论超选择脑动脉内溶栓可使血栓局部迅速达到较高的血药浓度,是治疗急性脑梗死的有效方法。

Objective To observe the effect of intra-arterial thrombolysis on the actute cerebral infarction. Methods Seventy patients with acute cerebral infarction were randomly divided into treatment group (40 cases) and control group (30 cases). The patients with cerebral infarction in the treatment group were treated by superselective intra-arterial thrombolysis in 3～12 hours after onset of the symptoms of cerebral infarction. Urokinase (UK) was infused into the infracted cerebral artery through the microcatheter at the rate of 15 000～20 000 unit/min. The total dosage of UK was 500 000～900 000 units. The patients in both the treatment and control groups were given routine treatment. The curative effect were evaluated 14 days after the treatment in the treatment and control groups. Results The total effective rates in the treatment and control groups were 90.0% (36/40) and 70.0% (21/30), respectively. There were significantly difference in the total effective rates between the two groups (P<0.05). The neurological deficit scale score in the treatment group were significantly lower than that in the control group (P<0.01). Conclusion The superselective intra-arterial thrombolysis is a valuable therapeutic method in the patients with acute cerebral infarction because the high UK concentration in the infarcted cerebral vassel can be reached by this method.