对急性脑梗死超时间窗溶栓的研究

Thrombolytic therapy with broadened therapeutic window for cerebral infarction

对超过溶栓治疗时间窗的病人 ,作静脉溶栓疗效和安全性的初步探讨。方法 将 94例急性脑梗死病人随机分为溶栓组和对照组。溶栓用国产尿激酶 ,联合甘露醇、葡萄糖 -胰岛素 -钾溶液、尼莫地平作为脑保护剂。溶栓组的病人 ,根据其能够得到溶栓治疗的时间 ,再分为时间窗内溶栓组 (6小时以内 )和超时间窗溶栓组 (12～ 2 4小时 ) ,对其疗效和安全性作对比观察。结果 超时溶栓组起效时间中位数 6小时 ,低于溶栓组 ,高于对照组 (10天 ) ;显效率和有效率明显高于对照组 ,低于溶栓组 ;恶化率与溶栓组相比无显著差异 ,无严重副作用。治疗后脑CT扫描梗死面积大于溶栓组 ,明显小于对照组。结论 在联合应用脑保护剂 ,注意治疗时间窗个体化前提下 。

Objective To study the curative effect and safety of thrombolytic therapy with broadened therapeutic window for cerebral infarction.Methods Of 94 acute cerebral infarction cases were divided into thrombolytic group(64 cases) and control group(30 cases) randomly.According to the time that the thrombolytict herapy could be given,the patients in thrombolytic therapy group were divided into therapeutic window group(within 6 hours of onset) and broadened therapeutic window group(12～24 hours after ictus),30 and 34 cases respectively.Both thrombolysis groups were treated with intravenous infusion of urokinase,combining with neuroprotective agents,the controls received common therapy.The results of treatment among the three groups were compared.Results The beneficial effect was observed in the earlist effect time,cure and markedly effect rate and the focus size on CT with thrombolytic therapy in broadened therapeutic window.There were no worsen cranial bleeding cases in both thrombolytic therapy groups.Conclusion Combining therapy trials with both neuroprotective drugs and urokinase,thetrombolytic therapy with 12～24 hours theraputic window is beneficial and safe. [