急性脑梗死尿激酶介入溶栓治疗临床观察

Clinical study of urokinase interventional thrombolysis in the treatment of acute cerebral infarction

目的 :探讨尿激酶 (U K)介入溶栓治疗急性脑梗死的疗效及并发症。方法 :采用 Selding′s技术经皮穿刺股动脉 ,将介入导管置入病灶侧颈内动脉行数字减影 (DSA)脑血管造影 ,经介入导管将 (4 0～ 80 )× 10 4U的UK缓慢灌注 30分钟 ,1小时后重复行 DSA脑血管造影 ;术后静滴 U K(5～ 10 )× 10 4U,每日 1次 ,连续 14日。结果 :血管完全再通 2例 ,部分再通 4例 ,血流量增加 6例 ,再通率 5 0 %。临床疗效评价 :治疗后 5日、14日神经功能缺损评分和生活能力状况与治疗前比较均有显著性差异 (P <0 .0 5和 P<0 .0 0 1) ;治疗后 5日显著进步4例 ,进步 6例 ,无变化 2例 ;治疗后 14日显著进步 8例 ,进步 4例 ;治疗后 14日与治疗后 5日相比临床疗效有显著性差异 (P<0 .0 5 )。并发症 :合并脑出血 1例 ,血管再闭塞 1例。结论 :对急性脑梗死患者于 72小时以内尽早用 U K介入溶栓治疗疗效好 ,不良反应小 。

Objective:To explore the efficacy and complications of urokinase(UK) in the treatment of acute cerebral infarction.Methods:According to Selding′s technique,a catheter was inserted into the lesionlocated internal carotid artery by means of percutaneous femoral artery insertion technique.The cerebral angiograph was performed with digital subtraction angiography(DSA) technique,and then (4080)×10 4 U of UK were infused slowly by means of mounted catheter within 30 minutes.Another cerebral angiograph was performed after one hour.After operation(510)×10 4 U of UK were slowly infused intravenously once a day,and continued for 14 days.Results:Recanalization:perfectly recanalised in 2 patients,partially recanalized in 4 patients,blood flow increased in 6 patients;recanalized rate was 50%.Clinical efficacy:nerve function scales (NFS) and life ability status(LAS) on 5 and 14 days after the treatment were significantly improved compared with those before the treatment ( P <0 05 and P <0 001).On day 5 after the treatment,4 cases improved significantly, 6 cases improved,2 cases unchanged.On day 14,8 cases significantly improved,4 improved.Clinical efficacy 14 days after treatment was significantly different from that after 5 days ( P <0 05).Complications:in this study,1 patient had complication of cerebral hemorrhage after the treatment,and in 1 patient reinfraction occurred.Conclusions:In the treatment of acute cerebral infarction,UK can be safely used intraarterially within 72 hours after attack,and there is little side effect.