急性脑梗死不同方式动脉溶栓治疗的临床研究

Individualized intra-arterial thrombolytic therapy in patients with acute cerebral infarction

目的探讨急性脑梗死患者不同方式机械性动脉溶栓治疗的方法、时间窗、溶栓药物剂量。方法选择海口市人民医院急性发病12h内的脑梗死患者60例，采用不同方式机械性动脉溶栓治疗（术中联合采用介入接触溶栓＋导丝机械疏通、球囊机械扩张、支架拉栓和联合血管内支架成形术等），通过脑血管造影判断其血管丌通情况并对其治疗疗效（依据神经功能缺损评分）进行评估。结果60例急性脑梗死患者中血管完全再通率为55％（33／60）．部分再通率为38.3％（23／60），未开通率为6．7％（4／60）；临床治愈38例（63．3％），显著好转10例（16．7％），有效9例（15％），无变化3例（5％），死亡0例。结论经不同方式机械性动脉溶栓是急性脑梗死的一种安全有效的治疗方法。建立急救绿色通道和规范其治疗措施，能较好的提高急性脑梗死患者救治成功率，降低死亡率和致残率。

Objective To investigate the method, time window, dosage ofthrombolytic drug used in different intra-arterial thrombolytic therapies of patients with acute cerebral infarction Methods Sixty patients with acute cerebral infarction within 12 h were chosen in our study; they were treated by different intra-arterial thrombolytic therapies. The therapeutic effect （recanalization） were evaluated through cerebral angiography. Results The complete recanalization rate was 55% （33/60）, partial recanalization rate 38.3% （23/60） and non-efficiency 6.7% （4/60）. Thirty-eight patients （63.3%） were clinically cured, 10 （16.7%） obviously improved, 9 （15%） partially improved and 3 （5%） invalid; no death was noted. Conclusion Treatment of acute cerebral infarction by different intra-arterial thrombolytic therapies is safe and effective. The cure rate will be improved and the death rate and disability rate will be decreased by setting up first aid system and standard therapeutic measurements.