急性脑梗塞的动脉内溶栓治疗

TREATMENT OF ACUTE CEREBRAL INFARCTION WITH INTRA-ARTERIAL FIBRINOLYSIS

目的 :探讨急性脑梗塞动脉内溶栓治疗的安全性和有效性。方法 :回顾 1997年 1月～ 2 0 0 2年 7月急性脑梗塞患者 178例 ,男性 10 6例 ,年龄 4 2～ 74岁 ,平均为 5 9岁。采用超选择性动脉内接触性溶栓方法 ,起病距溶栓的时间为 2～ 2 4小时。尿激酶以 1～ 1.2万U min持续泵入 ,总量为 5 0～ 130万U,平均 85万U。结果 :颈内动脉系统血管闭塞 117例 ,椎 -基底动脉系统闭塞 30例 ,脑血管造影未见明显异常 31例。闭塞血管再通于颈内动脉 14例 ,大脑中动脉 2 9例 ,大脑中动脉分支 30例 ,椎 -基底动脉系统 2 0例。 11例因明显的血管狭窄 ,溶栓后给予球囊扩张、支架置入术。临床症状完全恢复正常或明显好转 10 8例 ,并发脑出血 6例 ,消化道出血 15例。结论 :超选动脉内接触性溶栓 ,可使血栓局部迅速达到较高的血药浓度 ,疗效好 ,见效快 ,用药总量小 。

Objective: To evaluate the safety and efficacy of intra-arterial fibrinolysis in acute cerebral infarction. Methods: From January 1997 to July 2002, 178 patients with acute cerebral infarction were treated, of whom 106 were men, age ranged from 42 to 74 years old, the average age was 59. The durations from onset of symptoms to fibrinolysis were 2～24 hours. Urokinase was administered locally through the microcatheters by the pump at the rate of 10,000～12,000 unit/min. The total dosage of UK was 500,000 to 1.3 million units.The average dosage was 850,000 units. Results: 117 occlusions were found in ICA, and 30 in vertebral-basal artery. No obvious abnormality was identified in 31 cases. 14 recanalizations were achieved in ICA occlusions, 29 in middle cerebral artery, 30 in the branches of middle cerebral artery, and 20 in vertebral-basal artery. 11 patients received angioplasty with balloon and/or stents for severe stenoses of the vessels. The clinical outcomes of 108 cases were satisfied. Syndromes: 6 with the brain hemorrhage, 15 with the alimentary canal hemorrhage. Conclusions: Superselective local intra-arterial fibrinolysis for acute thrombosis of cerebral vessels is a valuable therapeutic modality. with good effectiveness, little dose, and few complications.