缺血性脑卒中超早期静脉溶栓治疗

Super-early Intravenous Thrombolysis in Acute Ischemic Stroke

目的 :评价超早期尿激酶静脉溶栓疗法对急性缺血性脑卒中的疗效和安全性。材料和方法 :随机选择 2 0例急性缺血性脑卒中患者 ,发病时间在 6h以内 ,半小时之内静脉滴注尿激酶 15 0× 10 4U/人 ,溶栓前、溶栓后 15min及 2 4h分别做血管造影检查 ,并记录比较患者溶栓前后临床神经功能缺损评分 (欧洲脑卒中评分 )及治疗 90天研究终点时的BarthelIndex和改良RankinScale。结果 :大脑中动脉闭塞 8例 ,6例完全再通 ,1例部分再通 ;大脑前动脉闭塞 1例 ,完全再通 ;颈内动脉闭塞 6例 ,3例部分开通 ,3例未通 ;豆纹动脉闭塞的 5例 ;4例临床完全恢复。本组病例中 2例继发症状性脑出血。有 3例患者死亡 ,死亡率为 15 %。结论 :超早期静脉溶栓可以使闭塞的血管再通 ,改善患者预后 ,但必需严格把握适应证 ,否则会增加脑出血的发病率及患者的死亡率。

purpose:To evaluate the efficacy and safety of intravenous thrombolysis using urokinase in patients with acute ischemic stroke.Material and Methods:A total of 20 patients were treated with urokinase 1500,000 Uper body within 6 hours from the onset of symptoms and under went cerebral angiography before and 15min,24h after the thrombolytic theuapy.Prunary end points included the European Stroke Scale at 2 hours,24 hours,2 days,7days,30days and 90 days.Second end points included Barthel Index and modified Rankin Scale at 90 days.Results:Among the 8 cases with occluded middle cerebral artery,6 cases were completely recanalized,1 case was recanalized partially.Among the 6 cases with occluded internal carotid artery,only 3 cases were recanlized partially.1 case with occluded anterior cerebral artery was completely recanalized.5 cases with lacunar infarcrion,4 cases were healed.Two patients had symptomatic intracranial hematomas.Mortality rate was 15% percent in this group at there months.Conclusion:Super-early intravenous thrombolysis in acute ischemic stroke can make the occluded vessel recanlization in many cases and improve the outcome.But intravenous thrombolysis therapy must be used to that adapted patients, otherwise the treating leads to unacceptabe high intracerebral hemorrhage.