急性脑梗死溶栓治疗时的出血并发症及其临床对策

Subsequent hemorrhage and its clinical management in patients with acute cerebral infarction by thrombolytic therapy

对急性脑梗死溶栓治疗时出血并发症及其临床对策进行分析。方法 研究应用尿激酶进行动脉和静脉溶栓治疗的不同类型急性脑梗死病例 ,出现出血并发症的临床特点和有效处理对策。结果 动脉溶栓组无发生出血和死亡病例 ;静脉溶栓组主干支梗死患者无出血并发症发生 ,而穿通支梗死患者病死率为 0 .0 2 5 % ,并发出血为 0 .7%。结论 急性脑主干动脉梗死应尽快动脉溶栓 ,以提高疗效和减少出血并发症。进行静脉溶栓药物的用量以 40～ 10 0万 U开始为好。如并发出血 ,临床只需停用抗凝和溶栓药 ,一般不需要其它特殊处理。

Purpose To explore the subsequent hemorrhage(SH) and its clinical management in patients with acute cerebral infarction by thrombolytic therapy.Methods We study clinical features and management of SH in patients with cerebral infarction of difference types by urokinase thrombolytic therapy by vein and artery.Results Artery thrombolytic groups have not the patients with SH and death note.The patients with cerebral arterial main trunk infarctions(CMTI) in vein thrombolytic groups have not one with SH.The mortality of patients with cerebral penetrating arterial infarctions(CPAI) in vein thrombolytic groups is 0.025%,and hemorrhage rate is 0.7%.Conclusions The patients with CMTI would be administered artery thrombolytic therapy in order to increase effectiveness and decrease SH.Primary thrombolytic dosage which is 40~100×10 4U better.We must stop using anticoagulant and thrombolytic and have no use for other management if SH.