超早期急性脑梗死的静脉溶栓治疗

Effects of intravenous thrombolysis in treatment of acute cerebral infarction at early stage

目的评价尿激酶(UK)对超早期脑梗死(发病6h内)的疗效及其安全性。方法对85例超早期脑梗死患者随机分成溶栓组和对照组。溶栓组给予UK 150万U,在30～40min内静滴,随后的治疗同对照组。对照组采用通常的治疗方法。评价治疗前和治疗后2h、6h、24h、2周、4周的神经功能缺损评分和随访6个月后的日常生活活动(ADL)能力。结果(1)治疗后2h、6h、24h、2周、4周时,溶栓组与对照组比较改善均非常显著(P＜0．01)；(2)治疗后4周末溶栓组的治愈率和显效率分别为48．9%和82．2%,高于对照组的15%和50%(P＜0．01、＜0．05)；(3)随访6个月,溶栓组ADL_(1,2)占64．2%,ADL_(4,5)4．8%,与对照组的30．6%、27．8%比较差异呈极其显著性和显著性(P＜0．01、＜0．05)；(4)脑实质出血死亡率溶栓组的2%,对照组无一例死于脑实质出血。结论UK用于超早期脑梗死的治疗比常规治疗起效快、效果好,致残率低,相对安全。

Objective To study the effects of urokinase （UK） in treatment of acute cerebral infarction （ACI） at early stage （within 6 hours after onset）. Methods Eighty-five ACI patients were randomly divided into thrombolysis group （TG） and the control group （CG）. The patients in TG were intravenously injected with UK 1500000 U within 30 to 40 minutes, and the other treatments were the same as those of CG. The patients in CG received routine treatment. The neurological function deficit scores （NFDS） were observed before treatment and at 2 hours, 6 hours, 24 hours, 2 weeks, g weeks after treatment. The activities of daily living （ADL） was evaluated after 6 months of following-up. Results （ 1 ） Compared with CG, NFDS was significantly improved at 2 hours, 6 hours, 24 hours, 2 weeks, g weeks after treatment （ P 〈0.01）. （2） At 4 weeks after treatment in TG, the curative rate and the response rate was 48.9% and 82.2% respectively, and was significantly higher than those （15% and 50%, respectively） in CG （ P 〈0.01, P 〈0.05）. （3） ADL1, 2 and ADL4, 5 in TG was 64.2% and 4.8% , respectively, after 6 months of following-up, while in CG was 30.6%, 27.8% respectively （ P 〈 0.01, P 〈 0.05）. （4） The mortality of cerebral hemorrhage was 2% in TG, and no one died of cerebral hemorrhage in CG. Conclusion UK in treatment of ACI at early stage was effective and safe.