超选择性动脉内灌注尿激酶治疗急性缺血性脑卒中

The Treatment of Acute Ischemic Cerebral Apoplexy by Super selective Intraarterial Infusion of Urokinase

目的：评价动脉内灌注尿激酶（ＵＫ）治疗急性缺血性脑卒中的安全性和疗效。材料与方法：在ＤＳＡ机下采用超选择性动脉内插管灌注ＵＫ治疗２２例急性脑卒中患者。平均发病时间１８．９小时，ＵＫ用量为３～９．５×１０５ＩＵ，灌注时间持续３０～６０分钟。结果：１０例患者即刻完全再通，其中１例术后１天重新闭塞。９例部分再通，３例未通。１３例脑血栓形成患者中８例完全再通，而９例脑梗塞患者仅２例完全再通，前者再通率高于后者。临床有效率６８．１８％，２例死亡。结论：超选择性动脉内灌注ＵＫ治疗急性缺血性脑卒中是一种安全可接受的方法，其疗效与栓子来源有关。

Objective: To evaluate the therapeutic effect and safety of intraarterial infusion of Urokinase (UK) for the treatment of acute ischemic cerebral apoplexy.Materials and Methods:Monitored by DSA, super selective intraarterial infusion of UK was performed in 22 patients suffered from acute ischemic cerebral apoplexy. The mean time from the onset of the illness to the beginning of infusion was 18.9 hours. The dose of UK was 3～9.5×10 5IU, being infused in 30～60 minutes.Results:Immediate complete recanalization was achieved in 10 patients, of which one patient re obstructed in the next day. Partial recanalization occurred in 9 patients and 3 patients remained occluded. Eight patients with cerebral thrombosis (8/13) recanalized completely. This recanalization rate was much higher (P<0.05) than that of patients with cardiogenic thromboembolism (2/9). Clinically, the response rate was 68.18%. Two patients died.Conclusion: Super selective intraarterial infusion of UK is a safe and acceptable treatment for acute ischemic cerebral apoplexy, and its effectiveness is related with the origin of the thrombus.