动脉内尿激酶介入治疗急性脑梗死的评价

Evaluation of intraarterial infusion of urokinase in patients with acute ischemic stroke

目的 评价动脉内尿激酶溶栓治疗急性脑梗死的结果 ,并明确影响预后的因素。方法 对4 8例急性颅内动脉闭塞患者在发病 6h内进行了局部动脉内尿激酶灌注治疗。结果 4 8例患者中有 17例(35 % )获得完全再通 ,其中 13例椎基底动脉阻塞者有 8例 (6 2 % ) ,2 0例大脑中动脉阻塞者有 9例(45 % ) ,而 15例颈内动脉阻塞者则无一例完全再通。 6 0 %大脑中动脉阻塞者神经状态得到改善 ,而椎基底动脉与颈内动脉阻塞者分别有 39%与 2 0 %得到改善 (P <0 0 5 )。总的死亡率为 2 1%。结论 大脑中动脉阻塞的患者血管完全再通后神经状态可得到改善 ,而椎基底动脉阻塞者再通与临床改善两者间并无必然联系 。

Objective To evaluate the results of intraarterial urokinase thrombolysis in patients with acute ischemic stroke and to define the factors affecting prognosis.Methods Forty-eight patients with angiographically proven occlusion of the intracranial arteries were treated with local intraarterial infusion of urokinase within 6 hours of symptom onset.Neurologic status was evaluated at admission and at discharge using the NIH stroke scale score(SSS).The clinical outcome was considered as improvement when the SSS decreased by at least 4.Results Complete recanalization was obtained in 17(35%) patients,including 8 of 13(62%) patients with occlusion of the vertebrobasilar artery(VBA),9 of 20 (45%) of the middle cerebral artery(MCA),and none of 15 at the internal carotid artery(ICA).Neurologic status improved in 12(60%) patients with MCA occlusion,5 (39%) of those with VBA occlusion and 3(20%) of those with ICA occlusion( P <0 05).The patients with complete recanalization of occluded MCA showed greater clinical improvement than those with partial or no recanalization( P <0 05).The overall mortality was 21%.The mortality was 43%(9/21) in patients with signs of early infarct on CT,but only 4%(1/27) in those without this sign( P <0 05).The mortality rate of patients with parenchymal hematoma(4/5) was higher than that of those patients with hemorrhagic infarct(3/9) or without hemorrhage(3/34) ( P <0 05).Conclusion Complete recanalization of occluded MCA could result in improvement of clinical outcome,patients with VBA occlusion did not benefit from recanalization. [