急性脑梗死患者动脉内介入治疗的临床体会

Study of intra-arterial interventional treatment in acute cerebral infarction

目的研究急性脑梗死患者动脉内介入治疗(选择性动脉内溶栓)的方法及疗效。方法 106例急性脑梗死患者,分为选择性动脉内溶栓组(SIAF组)、静脉溶栓组(IVF组)各53例;SIAF组采用改良Seldinger技术,选择性进入闭死的动脉,40分钟内泵入尿激酶50万单位+0.9%氯化钠60ml,随时做造影了解动脉通否,不通者再泵入尿激酶30万单位,只要闭死动脉再通,即撤除之。IVF组40分钟内静脉滴入尿激酶100万单位+0.9%氯化钠150ml,不通者再滴入尿激酶30万单位,余同上。结果溶栓后再通者SIAF组44例,IVF组33例(P<0.05);病情好转者SIAF组42例,IVF组30例;SIAF组死亡6例,IVF组死亡12例(P<0.05)。结论急性脑梗死患者动脉内介入治疗,效果明显。

Objective To study the method and results of intra-arterial interventional treatment （selective intra-arterial fibrinolysis ） in acute cerebral infarction （ACI）. Methods 106 patients with ACI were divided into two groups： 53 cases in selective intra-arterial fibrinolytic therapy group（SIAF） and intra-venously thrombolysis group （IVF） ; SIAF was selective entered into the obliterative artery with improved Seldinger＇s techniche, pumped urokinase （UK） in a dose of 500,000 i.u. in NS. 60ml within 40 minutes ; Arteriography was done all the time to know if the obliterative artery was unobstructed. If it remain obstructe, then pumps 300,000i. u. of UK. The treatment was finished as long as it was unobstructed; IVF was injected 1000,000 i.u. of UK in NS. 150ml by intravenous drip within 40 minutes, others was same with SIAF. Results The artery was recanalization after thrombolysis, 44 patients in SIAF,33 patients in IVF,P 〈0.05; the patients＇condition was good,42 in SIAF,30 in IVF,P〈0. 01 ;fatal cases,6 in SIAF, 12 in IVF, P〈 0. 05. Conclusion Selective intra-arterial fibrinolysis is a effective method of treating ACI, the response to treatment is dramatic.