经颅超声溶栓联合尿激酶治疗急性脑梗死患者的疗效观察

Efficacy of Transcranial Ultrasound Thrombolytic Therapy Combined with Urokinase in Patients with Acute Cerebral Infarction

目的:研究脑梗死发生6-72h内,持续静脉注射尿激酶,同时加用超声溶栓治疗,对急性脑梗死最终临床结局的影响。方法:实验共纳入2013年2-11月间共90名患者,随机数表法分为3组,每组30例,实验组A(超声频率800kHz+尿激酶20万U/d连续进行5d治疗),实验组B(尿激酶20万U/d进行治疗,总共治疗5d),及对照组C(予常规抗血小板聚集治疗),同时所有受试者加用清除氧自由基等治疗。患者疾病发展情况依据改良的美国国立卫生院卒中量表(NIHSS)进行评估,分别在实验开始初以及实验结束时(14d后)记录患者评分结果,同时记录凝血功能相关指标变化。结果:实验结果显示,NIHSS评分,实验组A,评分从13.2±5.2降至6.7±1.6;实验组B,评分从13.6±5.7降至8.7±3.6;对照组C,评分从13.4±5.4降至9.7±3.1,实验组A情况改善最明显,P<0.05。凝血相关指标纤维蛋白原、D-二聚体、vWF及血小板CD62P在实验开始初及实验结束后,各组间无明显差异,并未提示出血风险。结论:急性脑梗死发生6-72h内,应用尿激酶+超声溶栓治疗对预后有有效改善作用,且在溶栓治疗过程中,应用尿激酶没有明显出血倾向。

Objective： To evaluate the clinical combined effect of a continuous infusion of urokinase and transcranial ultrasound therapy in patients with cerebral stoke who were late admitted more than 6 hours, but less than 72 hours after onset. Methods： From Faburary to November in 2013, pa- tients with acute cerebral stroke （n = 90） were treated with intravenous urokinase infusion 200 000 U/d and transcranial ultrasound therapy 800 kHz for 5 days（Group A）, single treatment with intravenous urokinase infusion 200 000 U/d for 5 days（Group B）, or single antiplatelet ther- apy （Group C） after 6 hours and within 72 hours of stroke onset were reviewed. Continuous in- travenous infusion of urokinase was done for 5 d. The clinical outcome for each patient was evalu-ated by using the modified National Institutes of Health Stroke Scale （NIHSS）on admission and on the day of discharge. Results： The NIHSS score decreased at discharge compared with admis- sion in the urokinase treatment group（Group A from 13.2±5.2 to 6.7±1.6;Group B from 13.6±5.7 to 8.7±3.6;Group C from 13.4±5.4 to 9.7±3. 1,P〈0.05 ）. The NIHSS score de- creased at discharge in four groups, while Group A showed the most obvious changes compared with other groups. The changes of coagulation related indicators, FIG,D-Dimer,vWF and CD62P were also tested. The result showed no sign of hemorrhage risk. Conclusion： Within 72 hours from stroke onset, intravenous urokinase infusion and transcranial ultrasound therapy can be an effective modality in the treatment of acute inchemic stroke, with no obvious hemorrhage risk.