动脉内溶栓治疗急性脑梗死5例报告并文献复习

Intraarterial Thromlysis in Acute Cerebral Infarction:Five Case Report and Review Literature

目的：探讨超选择动脉内溶栓治疗急性脑梗死的适应证。方法：回顾性分析经超选择动脉内溶栓治疗的效果欠佳的急性脑梗死病例5例，均为男性，平均58．5岁；起病到接受治疗的时间为1～7h；其中4例用尿激酶以1～1．2万U／min持续泵入，总量50～92．5万U；1例用rt—PA以20～30mg／h的速度注入，总量25mg。结果：1例大脑中动脉闭塞，溶通但效果不佳；2例颈内动脉闭塞，其中1例部分溶通后出血，恢复良好，1例未溶通死亡；2例造影未见明显异常者，1例恢复良好，1例加重。结论：超选择动脉内溶栓时除应严格遵守治疗时间窗外，对伴有对侧代偿和（或）侧支循环形成者应根据具体情况决定是否需要溶通闭塞血管；而对造影未见明显异常者，应重视扩容、升压及抗凝等内科治疗。

Objective：To explore the indication of the super selective intraarterial thromlysis in the acute cerebral infarction. Methods ： 5 cases of typical acute cerebral infarction underwent super-selective intra-arterial thromlysis were retrospectively analyzed. All the 5 patients were male with average age 58.5 years. The time between stroke onset to intra-arterial thromblysis application was 1-7 hours. 4 cases were injected with urokinase 10 000-12 000 U/min and total doses are 500 000-925 000 U. 1 case was injected with rt-PA 20-30 mg/h and total dose was 25 mg. Results：One case with middle cerebral artery occlusion was revascularized but gained no good outcome. Two cases were internal carotid artery occlusion,out of which one case occurred bleeding after revascularization, but the outcome was good. The other case failed to be revascularized and died. Two cases had not abnormal finding in the angiography, one recovered well ,the other aggravated. Conclusion ：Super-collective intraarterial thromblysis should be applied within the therapeutic time window strictively. For the cases with good compensatory circulation,it should be individually to decide if it necessary to revascularize the occluded vessle. For the cases without abnormal findings in the angiography,emphasis must be paid on the medication therapy such as fluid expansion,boosting blood pressure and anticoagulation.