尿激酶静脉溶栓后早期血管再闭塞的原因分析

Factors of early arterial reocclusion after intravenous urokinase infusion

目的探讨尿激酶静脉溶栓后早期血管再闭塞的原因。方法对16例大脑中动脉闭塞后应用尿激酶静脉溶栓的患者，治疗前行经颅多普勒（TCD）及颈动脉超声检查，溶栓治疗开始后行TCD监测并且持续2h，如溶栓后2～24h内临床症状恶化而头颅CT无脑出血，则再次行TCD检查，溶栓前及溶栓后24h内行NIHSS评分。结果尿激酶静脉溶栓2h后，血管再通率为68．8％，早期血管再闭塞率为18．8％，溶栓前NIHSS评分〉16分及合并同侧颅外颈动脉高度狭窄为再闭塞的预测因素。结论溶栓前脑梗死的严重程度及合并同侧颅外颈动脉严重狭窄能预测尿激酶静脉溶栓后早期血管再闭塞。

Objective To approach the factors of early arterial reocclusion in ischemic stroke patients treated with intravenous urokinase.Methods Transcranial Doppler ultrasound （TCD） continous monitoring and carotid ultrasound were performed before and after intravenously thrombolytic therapy in 16 patients with middle cerebral artery occlusions treated with intravenous urokinase. TCD monitoring was performed during the first 2 hours after urokinase infusion and repeated when clinical dete-rioration occurred 2-24 hours after thrombolytic therapy in absence of intracranial hemorrhage. National Institutes of Health Stroke Scale （NIHSS） scores were obtained before and serially within 24 hours. Results After 2 hours of urokinase administration, the percentage of recanalization was 68. 8%, the percentage of early reocclusion was 18. 8%, NIHSS score 〉16 before thrombolytic therapy and ipsilateral severe carotid stenosis were predictors of reocclusion. Conclusion Stroke severity before thrombolytic therapy and ipsilateral severe carotid stenosis can predict early reoeclusion after intravenously thrombolytic therapy.