颈动脉灌注小剂量尿激酶并联合纳络酮治疗急性脑梗死的临床研究

Clinical Study of Acute Cerebral Ischemic Infarction Treated by Carotid Injection Small Dosage Urokinase and Naloxone

目的:观察颈动脉灌注小剂量尿激酶和静脉注射纳络酮对急性脑梗死的疗效。方法:经颅脑CT或MRI确诊为脑梗死患者80例,随机分为颈动脉灌注小剂量尿激酶和静脉注射纳络酮治疗组40例(治疗组)和常规治疗组40例(对照组)。本研究中对照组,经CT或MRI确诊的脑梗死患者,给予常规的降颅压和阿司匹林、尼莫地平、静脉注射尿激酶等治疗;治疗组在常规的降颅压等治疗的基础上给予颈动脉灌注N.S100ml+尿激酶20万U1次,加用纳络酮2mg/d静脉注射,1次/d,连用7天。并在治疗后1、3、7、14d分别进行临床疗效的评定。结果:治疗组在术后12h、1、7d的总有效率明显高于对照组;在发病后12h内行灌注治疗的有效率在术后2、12h时的有效率明显高于在发病后12～48h行灌注治疗病例的有效率;治疗组灌注治疗后PT和APTT延长的发生率明显低于对照组。结论:脑梗死发病超早期进行颈动脉灌注小剂量尿激酶和静脉注射纳络酮治疗是安全且有效的一种治方法。

Objective： To observe efficacy of carotid injection small dosage Urokinase and Naloxone treating acute cerebral ischemic infarction. Methods： 80 patients with cerebral ischemic infarction were divided randomly into combined treatment group and control group. The former were treated with a single dose of 20×10 4 urokinase and 2mg Naloxone as carotid injection（one time per day, for 7 days）. In the same time, decreasing intracranial pressure drugs were applied. The scores of therapy were recorded after the treatment at different intervals （2h, 12h,1d, 3 d, 7 d, 14 d）, While the latter was treated with decreasing intracranial pressure and aspirin, Nimodipine urokinase et ac. Results： The total efficiency of combined treatment group was more obvious than control group at 12th hour, 1st day, 7th day after treatment. And the former Incidents of prolonged PT and APTT was more lower than the later. Conclusion： Carotid injection small dosage urokinase and Naloxone were safe and effective for acute cerebral ischemic infarction.