超选择动脉内溶栓治疗脑急性缺血性卒中

Treatment of acute ischemic stroke patients with superselective intra-arterial fibrinolysis

目的探讨脑急性缺血性卒中患者动脉内溶栓治疗的安全性和有效性. 方法回顾 1997年 7月至 2002年 7月脑急性缺血性卒中患者 165例,男 97例,女 68例.年龄 32～ 74岁,平均为 58岁.采用超选择动脉内溶栓方法,起病距溶栓的时间为 2～ 24 h.尿激酶以 1～ 1.2万 U/min持续泵入,总量为 50万～ 130万 U,平均 85万 U. 结果颈内动脉系统血管闭塞 108例,椎基底动脉系统闭塞 27例,脑血管造影未见明显异常 30例.闭塞血管再通者,颈内动脉 14例,大脑中动脉 27例,大脑中动脉分支 28例,椎基底动脉系统 19例. 10例因明显的血管狭窄,溶栓后给予球囊扩张、支架置入术.神经系统症状完全恢复正常或明显好转 105例 ,并发脑出血 6例,消化道出血 13例. 结论超选择动脉内溶栓可使血栓局部迅速达到较高的血药浓度,用药总量小,疗效好,见效快,是治疗脑急性缺血性卒中的有效方法.

Objective To evaluate the safety and efficacy of intra - arterial fibrinolysis for acute thrombosis of cerebral vessels. Methods From July of 1997 to July of 2002, 165 patients with acute ischemic stroke, male 97, female 68, age ranged from 32 to 74 years old, the average age was 58. The durations from onset of symptoms to fibrinolysis were 2 - 24 hours. Urokinase was administered locally through the microcatheters by the micro pump at the rate of 10,000 - 12,000 unit/min. The total dosage of UK was 500 000 units to 1. 3 million u-nits. The average dosage was 850 000 units. Results 108 occlusions were found in ICA, and 27 in vertebral -basal artery. No obvious abnormality was identified in 30 cases. 14 recanalizations were achieved in ICA occlusions, 27 in middle cerebral artery, 28 in the branches of middle cerebral artery, and 19 in vertebral-basal artery. 10 patients received angioplasty with balloon and/or stents for severe stenoses of the vessels. The nervous system symptoms of 105 cases recovered completely or satisfactorily. Complications: 6 with the brain hemorrhage, 13 with the alimentary canal hemorrhage. Conclusion Superselective intra-arterial fibrinolysis for acute thrombosis of cerebral vessels is a valuable therapeutic modality, with small dose, high blood concentration, good effectiveness.