急性脑梗死溶栓治疗的药物选择

DRUG SELECTION FOR THROMBOLYTIC THERAPY IN ACUTE CEREBRAL INFARCTION

①目的 比较国产尿激酶（ Ｕ Ｋ）与组织型纤维蛋白溶酶原激活剂（ｔ Ｐ Ａ）溶栓治疗的优缺点。②方法选择符合溶栓治疗标准急性脑梗死病人３８ 例，随机分为ｔ Ｐ Ａ 组（２２ 例）与 Ｕ Ｋ 组（１６ 例），静脉滴注 Ｕ Ｋ 或 ｔ Ｐ Ａ行溶栓治疗，溶栓成功后立即肝素抗凝治疗２４ 或４８ｈ，溶栓前后行 Ｅ Ｓ Ｓ评分，比较两组病人的治愈率、病死率、脑内出血率、再梗死发生率。③结果 溶栓治疗后 ２ｈ Ｕ Ｋ 组与ｔ Ｐ Ａ 组治愈率比较，差异有极显著性（ Ｐ＝ ０．０００ １），溶栓后７，３０ｄ 两组治愈率、病死率、脑内出血率、再梗死发生率比较，差异无显著性（ Ｐ＝ ０．１１１ ０～０．５１０ ０）。④结论ｔ Ｐ Ａ 溶栓疗效肯定，起效快速； Ｕ Ｋ 溶栓虽起效较慢，但溶栓治疗同样有效。

Objective\ To determine the advantages and blemishes of tissue plasminogen activator (t PA) and urokinase (UK) in thrombolytic therapy.\ Methods\ 38 patients with acute cerebral infarction were randomly divided into 2 groups: UK group( n =22) and t PA group ( n =16). UK or t PA was administered to the patients by intravenous infusion. Heparin was administered to the patients for 24 or 48 hours as soon as the thrombolytic therapy was finished successfully. Comparisons about curative effects and complications between t PA group and UK group were done.\ Results\ A comparison between t PA group and UK group showed that the recovery rate 2 hours after thrombolytic therapy was significant different ( P =0.000 1). No significant differences between t PA group and UK group in cure rate, mortality and so on were shown 7 and 30 days after thrombolytic therapy ( P =0.111 0-0.510 0).\ Conclusion\ The curative effect of t PA in thrombolytic therapy is very affirmative and rapid. UK is also effective for thrombolytic therapy, but the curative effect of UK is slower than that of t PA.\;