急性缺血性脑梗死动脉溶栓介入治疗的价值及临床研究

The Value and the Clinical Study of Intra-Artery Thrombolytic Therapy for Acute Ischemic Cerebral Infarction

目的 :观察动脉内溶栓治疗急性缺血性脑梗死的临床疗效和安全性 ,分析影响预后的相关原因。材料与方法 :对 16例发病在 2～ 8h内的急性缺血性脑梗死患者进行颈动脉内溶栓治疗。血管再通程度根据TIMI血流分类。尿激酶平均用量6 0万单位。患者病情在入院时由神经科医生用美国国立卫生研究院卒中分数 (NIHSSS)综合评分。临床结果评价在溶栓后 3个月进行 ,根据ModifiedRankScore (MRS)分为好结果 (MRS 0～ 3) ,差结果 (MRS 4～ 6 )两类。结果 :闭塞时间 <6h的 12例中 ,TIMI0～I级 ,溶栓后部分 /完全再通 11例 ,闭塞时间在 6～ 8h 4例中 ,TIMI 0～I级 ,溶栓后部分 /完全再通 2例。 13例患者(81 2 % )为好结果。 3例 (18 8% )为差结果。良好的预后与入院时NIHSSS评分的高低与溶栓治疗后血管再通有密切相关 (P<0 0 1)血管再通与开始溶栓时间 <6h (P <0 0 5 )有关。结论 :动脉内溶栓治疗急性缺血性脑梗死是一种安全有效的方法 ,使大部分患者闭塞动脉再通 ,能明显降低死亡率和改善预后。急性脑卒中后开始溶栓时间与疗效成反比关系。

Purpose:To evaluate the clinic effects and the safety of intra-arterial thrombolytic therapy for acute ischemic cerebral infarction and analysis the influence of clinical and radiological parameters on outcome.Materials and Methods:16 patients were treated with intra-arterial thrombolysis using urokinase (median dose,60×104 IU).Angiographic recanalization was classified according to thrombolysis in myocardial infarction(TIMI) grades.The time from onset to treatment was 2～8 hours.The patients condition ws assessed by neurologists using National Institutes of Health Stroke Scale Score (NIHSSS) at admittance to the hospital ,Clinic outcome was assessed after 3 months and classified as good for Modified Rankin Scale (MRS)scores of 0 to 3 and poor for MRS scores of 4 to 6.Results:Follow up cerebral angiography of 12 cases treated within 6 hours showed complete/partial recanalization in 11 cases,other 4 patients whose treatment started beyond 6 hours outcome with complete/partial in 2 cases.13 cases(81.2%)of the 16 patients had good outcome according to TIMI 0～I.3 cases (18.8%) had poor outcome.Good outcome was associated with an initial NIHSSS score (P<0.01)and vessel recanalization.Recanalization was more likely if delay to thrombolysis within 6 hours(P<0.05).Conclusion:Intra-arterial thrombolysis is a safe and offective therapy for acute ischemic cerebral infarction.