急性大面积脑梗死新治疗方案的应用

A new treatment of acute massive cerebral infarction

目的分析大面积脑梗死的特点,探讨降低患者病死率的新内科治疗方案。方法 56例急性大面积脑梗死患者,予以规范抗栓治疗、严格控制性补液、使用白蛋白改善脑灌注、尽早使用人尿激肽原酶、禁用扩血管药物、控制高危因素及加强并发症处理,总结这些病例的临床特征和治疗经验。结果治疗后4 d查头颅MRA均证实均为大脑中动脉梗死,死亡仅2例,放弃治疗2例,其余52例患者无任何颅内高压的表现,平稳渡过脑水肿高峰期,(21±4)d后52例患者均好转出院,发病1个月时所有患者病死率7.14%。结论新治疗方案优于传统方案,能明显降低病死率,疗效显著,值得临床推广。

Objective To analyze the characteristics of massive cerebral infarction,thus to explore medical treatment reducing the mortality. Methods 56 patients with acute massive cerebral infarction were given a new treatment,including normative antithrombotic therapy,restricted fluid infusion,application of albumin to improve cerebral perfusion,application of human urinary kallidinogenase as early as possible,prohibition of using vasodilators,controlling risk factors and strengthening treatment of complications. All of above were summarized. Results Osmotic dehydrants,including mannitol,were not applied in all cases. Middle cerebral artery infarction was revealed in all cases 4 days after treatment by MRA. Two deaths and 2 cases with refusal for treatment were recorded,while the other 52 patients without high intracranial pressure recovered（ 21 ± 4） days after treatment. The mortality of one month in all patients was 7. 14%.Conclusion This new treatment is superior to the traditional one,which significantly reduces mortality.