动脉内溶栓后低分子肝素治疗急性脑梗死11例

Urgent intra-arterial thrombolysis and low molecular weight heparin therapy for acute cerebral infarction: a report of 11 cases

目的观察急诊动脉内溶栓加低分子肝素治疗急性脑梗死的疗效及预后。方法对11例治疗时间窗在6h内的急性脑梗死患者行动脉内溶栓治疗。术前及术后24h均行神经功能评价(美国国立卫生研究院卒中量表,NIHSS)。术后根据急性心肌梗死溶栓标准灌注分级(TIMI)评价血管再通程度。溶栓后20d,皮下注射低分子肝素钙5000U。20d后,根据改良的Rank分数法(MRS)评价独立生活能力。结果溶栓前,患者NIHSS评分平均为17±8,术后24h为10±9,溶栓前后比较差异有显著意义(P<0.05)。24h神经功能评价,7例改善,4例无改善,差异有显著意义(P<0.05)。溶栓后7例患者完全再通,1例部分再通,3例未再通。MRS评分,8例患者疗效良好,3例疗效差,其中1例死亡。结论急诊动脉内溶栓是安全、可行的,溶栓后24h神经功能检查改善程度与20d后临床疗效密切相关,用低分子肝素作为溶栓后续治疗安全有效。

Objective To study the effect a nd complications of intra-arterial thrombolysis (IAT) and low-molecular-weight heparin in the treatment of acute ischemic stroke. To analyze the predictive fac tors related to the outcome. Methods 11 patients of acute isc hemic stroke were treated by IAT using urokinase(UK) within 6 h of onset in our hospital. Mechanical thrombolysis was attempted before UK was infused.Angiograp hic recanalization was classified according to Thrombolysis In Myocardial Infarc tion(TIMI).Clinical outcome was classified as good for Modified Rankin Scale (MR S)scores of 0 to 3 and poor for MRS scores of 4 to 6. Results There were 6 patients TIMI 0-1 and 5 patients TIMI 2 before thrombolysis was performed. The rates of complete/partial recanalization just after infusion wer e 8 cases and minimal or no recanalization were 3 cases.8 of the 11 patients had good outcome and 3 had poor outcome. Conclusion IAT is feasi ble and safe in patients suffered from acute stroke. Improvement by 4 or more po ints on NIHSSS within 24 hours was significantly associated with good outcome. W hether adopting the mechanical disruption method was determined by the time of stroke onset and occlusion site. low-molecular-weight heparin in the thrombol ysis treatment of acute ischemic stroke was safe and feasible.