“病理生理窗”指导下的溶栓干预模式探讨

目的:分析“时间窗指导下的溶栓治疗”的局限性,提出新型溶栓干预模式。方法:本研究通过对比分析5例急性缺血性脑血管病患者“时间窗”、“缺血半暗带”和“溶栓干预疗效”之间的相关关系。阐释“时间窗指导下溶栓治疗”的局限性,进而提出新型急性脑血管病溶栓干预模式的设想。结果:“时间窗”指导下的溶栓治疗有其固有的局限性,集中体现在以下两个方面。其一,对于那些发病虽然在经典溶栓干预时间窗内。但已经无缺血半暗带存在的患者实施了溶栓治疗,增加出血并发症发生的机率。其二,对于那些发病虽然超过经典时间窗,但仍然有可挽救脑组织存在的患者却放弃了溶栓治疗,降低了患者从溶栓治疗中受益的机会。结论:“病理生理窗指导下的溶栓治疗”,倡导根据缺血的病理生理特点进行溶栓决策,实施个体化的溶栓治疗,是一种更为理想的溶栓干预模式。

Objective： To analyze the limitation of acute ischemic stroke thrombolysis guided by time window and proposes a new promising treatment model. Methods： In present research, 5 representative acute ischemic stroke patients receiving thrombolytie therapy were presented. By comparing the relationship among ＂thrombolytie time window＂, ＂penumbra＂, and ＂the effect of thrombolytic treatment＂ of each patient, the author elucidated the limitation of traditional thrombolytic treatment and another novel thrombolytic model guided by pathophysiological window was suggested. Results： The limitation of thrombolytic therapy guided by time window mainly focused on the following two aspects： one was that thrombolysis was arbitrarily carried out for those patients whose stroke onset was within traditional time window, but no obvious penumbra existed. This way could only increase the likelihood of hemorrhagic complication; the other was that thrombolysis was arbitrarily abandoned for those patients whose stroke onset was beyond traditional time window, but indeed obvious penumbra was present. This would only blunder away the opportunity for these patients to benefit from thrombolytic therapy. Conclusion： Thrombolytic treatment guided by pathophysiological window but not time window, advocating thrombolytic decision-making based on the pathophysiological characteristics of ischemic events, is a more scientific and effective thrombolytic model.