重组组织型纤溶酶原激活剂动静脉联合溶栓治疗急性脑梗死疗效观察

Study on efficacy of combined intravenous and intra-arterial thrombolytic treatment of acute ischemic stroke with rt-PA

目的评价重组组织型纤溶酶原激活剂(rt-PA)动-静脉联合溶栓治疗急性脑梗死的疗效及安全性。方法选择符合入选标准的急性脑梗死患者48例,分为动-静脉联合溶栓组(溶栓组)24例和对照组24例。溶栓组先按0.6 mg/kg计算静脉rt PA用量,10%静脉推注,余量在60 min内滴完。随后行数字减影血管造影检查,血管闭塞者,酌情给予rt-PA 5～20 mg超选择接触性溶栓。对照组应用低分子右旋糖酐500 ml加复方丹参16 ml静脉滴注,1次/d,连用8 d。采用欧洲脑卒中神经缺损评分量表(ESS)、Barthel指数评价神经功能恢复状况。结果与对照组比较,溶栓组患者在溶栓后24 h、21 d ESS评分明显升高(P<0.05)。溶栓组(58.3%)明显高于对照组(25.0%)。结论小剂量rt-PA及时静脉溶栓,延长了治疗时间窗,联合动脉溶栓又提高了血管再通率,促进了临床预后的改善。

Objective To investigate the efficacy and safety of combined intravenous（IV） and local intra-arterial（IA） recombinant tissue plasminogen activator（rt-PA） in treatment of patients with acute ischemic stroke. Methods Forty-eight acute stroke patients consistent with the inclusion criteria were divided into the IV/IA thrombolysis group and control group. An IV dose of 0. 6 mg/kg rtPA was given,with 10% given as an initial bolus and the remainder given as a constant infusion over 60 minutes, rt-PA 5-20 mg was then given as IA administration in the IV/IA thrombolysis group;whereas the control group received only routine treatment. European Stroke Scale（ESS） and Barthel Index（BI） were used to evaluate the recovery of neurological functions. Results The efficacy in the IV/IA thrombolysis group was significantly higher than that in control group （P 〈.05）. Conclusion Combined treatment that uses immediate initiation of therapy with IV rt-PA to prolong the treatment time window and rapid local IA administration of rt-PA to improve recanalization efficacy may improve clinical outcome after acute ischemic stroke.