干预急性脑梗死尿激酶静脉溶栓后再闭塞的临床研究

Clinical study on prevent measures of early reocclusion after urokinase intravenous thrombolysis of acute cerebral infarction

目的评价急性脑梗死(发病3h内)静脉溶栓后6h追加尿激酶(UK)对再闭塞的干预效果及安全性。方法发病3h内急性脑梗死患者,首先用100万U UK静脉溶栓治疗,后选取50例溶栓有效的患者随机于溶栓6h内分别予以静脉追加UK 50万U(B组)及基础治疗(A组)。分别各25例,观察各组于入院时、溶栓后2h、6h时、24h的美国国立卫生研究院卒中量表(NIHSS)评分;观察溶栓后3d、14d、30d、90d的Barthel指数(BI)、改良的Rankin残障(mRS)评分及死亡率、症状性脑出血、再闭塞的发生率。结果溶栓后2h、6h两组患者NIHSS评分均迅速增加,无显著差异,24h NIHSS分数两组间有显著差异,分别为A组:10.11±4.54;B组:7.51±4.32。90d时,BI≥75者:A组11例(44%),B组18例(72%);mRS≤2者:A组10例(40%),B组17例(68%);病死率:A组0%,B组0%;症状性脑出血率:A组0%,B组0%;再闭塞发生率:A组6例(24%),B组1例(4%)。结论急性脑梗死(发病3h内)静脉溶栓后6h追加50万U尿激酶的治疗对再闭塞的干预是安全、有效的。

Objective To evaluate the efficacy and safety of additional intravenous urokinase（UK）therapy in re-occlusion of intravenous thrombolysis in acute cerebral infarction（onset within 3 hours）.Method Patients were treated with UK 1MU intravenous thrombolysis within 3 hours of onset,50 patients which were effective to thrombolysis,were randomly divided into Group A（n=25）and Group B（n=25）.The patients in group B received additional UK 0.5MU and group A as control.National Institutes of Health Stroke Scale（NIHSS）score befor and after intravenous thrombolysis 2h,6h,24h,the Barthel Index（BI）score and modified rankin scale（mRS）score after intravenous thrombolysis 3d,14d,30d,90d were observed,the mortality,symptomatic cerebral hemorrhage and the incidence of re-occlusion were observed.Results NIHSS scores were rapidly increasing 2 hours,6 hours after thrombolysis,there were no significant difference between the two groups,but after 24 hours NIHSS scores between the two groups were significantly different,group A：10.11±4.54;group B：7.51±4.32.At 90 days from onset,BI ≥ 75：group A,11 cases（44%）;group B,18 cases（72%）;mRS ≤ 2：groupA,10 cases（40%）,Group B,17 cases（68%）;The mortality rate and Symptoms of cerebral hemorrhage rate：group A 0 cases（0%）,group B 0 cases（0%）;Re-occlusion rate：group A 6 cases（24%）,group B 1 cases（4%）.Conclusion The therapy Adding urokinase to prevent early re-occlusion after six hours of urokinase intravenous thrombolysis of acute cerebral infarction（onset within 3h）were safety and efficacy.