间断溶栓治疗急性大面积肺栓塞疗效观察

目的观察间断溶栓治疗对急性大面积肺栓塞的临床疗效。方法84例确诊大面积肺栓塞的病人应用尿激酶50-100万IU静脉点滴,每日1次,连续7-10 d,继之改用低分子肝素抗凝治疗以减少肺栓塞的复发。结果治愈64例,显效15例,好转1例,无效4例,有效率达94.04%,出血发生率5.4%。结论采用间断溶栓治疗与中华医学会呼吸病学分会推荐我国的PTE采用标准溶栓方案治疗疗效相当,出血发生率低。

溶栓颗粒治疗急性缺血性中风68例临床研究

目的：观察溶栓颗粒治疗急性缺血性中风的疗效。方法：将128例急性缺血性中风患者随机分成3组，在一般内科治疗基础上分别口服溶栓颗粒（治疗组）、溶栓胶囊（对照组1）、尼莫地平（对照组2），治疗3周，观察临床疗效。结果：治疗组临床疗效优于对照组1、对照组2（P〈0．05），3组治疗后与治疗前比较症状均有明显改善（P〈0．05），治疗组证候疗效优于对照组1、对照组2（P〈0．05）。结论：溶栓颗粒是治疗急性缺血性中风的有效药物。

老年急性心肌梗塞溶栓治疗护理体会

目的 介绍溶栓疗法对老年急性心肌梗塞 (AMI)疗效和护理措施。方法 老年急性心肌梗塞患者入院后常规给尿激酶溶栓 ,同时给予溶栓护理。结果 10 2例老年AMI患者有效 82例 ,有效率 80 %。

静脉溶栓联合依拉达奉治疗急性脑梗死的疗效分析

目的研究依拉达奉联合尿激酶静脉溶栓对急性脑梗死患者的临床疗效。方法选取急性脑梗死患者80例,按照随机数表法将其分为研究组和对照组,每组40例。对照组给予尿激酶静脉溶栓治疗,研究组在对照组的基础上联用依拉达奉进行治疗。对比两组患者治疗前、治疗1周、2周、3周后的神经缺损情况以、日常生活能力及治疗总有效率。结果治疗1周、2周、3周后,两组的神经功能缺损情况均有所改善,生活能力均有所提升,研究组的改善和提升程度均明显高于对照组(P<0.05)。两组治疗总有效率比较,P<0.05。结论将依拉达奉与尿激酶静脉溶栓联合用于治疗急性脑梗死患者,不仅可改善患者的神经功能,还可以提高患者的生活能力,治疗效果较为理想。

芎蛭溶栓方对脑梗死模型大鼠血液流变学的影响

目的:探讨芎蛭溶栓方对脑梗死的作用机制。方法:采用线栓法复制大鼠脑梗塞模型,观察不同剂量芎蛭溶栓方对其血浆PGI2、TXA2的影响及血液流变学变化。血浆PGI2和TXA2水平采用ELISA法测定。血液流变学采用血液流变学检测仪进行测定。结果:芎蛭溶栓方可明显降低血浆TXA2水平,升高PGI2水平,调节两者的平衡;对脑梗死大鼠的血液流变学指标有明显的改善作用。结果:芎蛭溶栓方治疗脑梗死作用机理之一是其能够调节TXA2/PGI2平衡,改善血液流变学。

Acute extensive portal and mesenteric venous thrombosis after splenectomy:Treated by interventional thrombolysis with transjugular approach

AIM:To present a series of cases with symptomatic acute extensive portal vein(PV)and superior mesenteric vein(SMV)thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS:A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 years.After access to the portal system via the transjugular approach,pigtail catheter fragmentation of clots, local urokinase injection,and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis,followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV,which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization,and after discharge. RESULTS:Technical success was achieved in all 6 patients.Clinical improvement was seen in these patients within 12-24 h of the procedure.No complications were observed.The 6 patients were discharged 6-14 d(8±2.5 d)after admission.The mean duration of follow-up after hospital discharge was 40±16.5 mo.Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV,and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period. CONCLUSION:Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

Combination of thrombolytic therapy and angioplastic stent insertion in a patient with Budd-Chiari syndrome

A 31-year-old female who had well-established polycythemia vera one year before, presented with the sudden onset. She had severe ascites and hepatic encephalopathy 12 d prior to admission. Real-time ultrasonography revealed a supra hepatic thrombosis extending toward the inferior vena cava （IVC）. Thrombolytic therapy with systemic streptokinase （250000 IU loading ＋ 100000 IU/h infusion） was started. At the end of 72 h infusion, the patient＇s general condition improved. A color Doppler ultrasonography then showed complete and partial resolution of the thrombosis in the supra hepatic vein and IVC, respectively. Despite this good response, 12 d later, the symptoms recurred. Venography detected complete obstruction of the IVC. Percutanous balloon angioplasty with stent insertion was performed successfully and the patient was discharged without any evidence of liver disease. A combination of systemic streptokinase and radiological intervention was effective in our patient.

PROCOAGULANT EFFECTS OF THROMBOLYTICTHERAPY IN ACUTE MYOCARDIAL INFARCTION

To examine the procoagulant effects of thrombolytic agent on h emostasis and study the role of hemostatic markers as predictors of clinical outcomes. Methods. In the present study, eighteen patients with acute myocardial in farction(AMI) received 1.5 or 2.0 million U nonspecific urokinase(UK), or 70～80 mg fibrin specific recombinant tissue plasminogen activator(rt PA)and did not use heparin until 8 hours after intravenous injection of the above agents. Eig ht patients with AMI and without thrombolytic therapy were enrolled as controls. Coagulant and thrombolytic activity markers included thrombin antithrombin Ⅲ complex (TAT), D dimer, fibrinogen (Fg), FMPV/Amax. All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic a gents respectively. Results. Molecular marker of thrombin generation——TAT showed an activated coa gulant state immediately after thrombolytic therapy. Level of TAT showed no sign ificant changes between every two observed phases in controls. However, level of TAT increased significantly from 4.95±1.75μg/L ( 4.63±1.37μg/L) to 14.71±3 .31μg/L ( 14.25±2.53μg/L) before and immediately after administration of thro mbolytic agents UK(or rt PA). There was significant difference between level of serum TAT of patients with and without thrombolytic therapy (P< 0.05). Patients achieving clinical reperfusion had lower TAT level than those failing in thromb olytic therapy, and higher FMPV/Amax level than controls. D dimer, a surrogate of thrombolytic activity increased markedly and Fg significantly declined afte r thrombolytic therapy(P< 0.05).Conclusions. Thrombin generation occurred in plasma in response to excess fibri nolysis induced by thrombolytic therapy. Both urokinase and rt PA had procoagul ant action. This transient activation of the coagulant system might contribute t o early reocclusion. These data provided the theoretical support for simultaneou s administration of anticoagulant therapy with thrombolytic agents. These result s also suggested that TAT might be useful in predicting clinical outcomes of p atients treated with thrombolytic therapy for AMI.

Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

Objective: To explore the effect of thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis of lower extremity. Methods: The clinical data of 106 patients at the early stage of deep vein thrombosis (DVT) in the lower extremities treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results: The thrombolytic effect was significant. After treatment, the deep veins were recanalized without regurgitation in 75.3% of the patients. The total effective rate was 100%. Only three patients had hemorrhagic complication, but none of the patients died. Conclusion: Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.

A COMPARATIVE STUDY OF INTRAVENOUS ACCELERATED STREPTOKINASE DOSE REGIMEN WITH CONVENTIONAL DOSE REGIMEN FOR CORONARY THROMBOLYSIS

The aim of this study is to test the patency rate and safety of the accelerated streptokinase dose regimen for coronary thrombolysis compared with the conventional one. One hundred and four patients enterring three hospitals up to 12 hours after the onset of definite acute myocardial infarction were randomizely treated with intravenous accelerated streptokinase dose regimen ( 1. 5 million units/30 min) (group A, 47 cases) and conventional dose regimen ( 1. 5 million units/60 min) (group B , 57 casese). The reperfusion rate of infarct-related arteries determined by clinical evidence of reperfusion was 76. 6% (36/47) in group A VS 61. 4% (35/57) in group B. There was significant difference in reperfusion rates among patients within 6 hours after the onset of chest pain : 87. 9% (29/33) in group A VS 67. 4 (29/43) in group B(P<0. 05 ). The incidence of mild bleeding , allergic reaction , hypotension was 12. 8 % ( 6/47 ) , 4. 3 % ( 2/47 ) , 12. 8 ( 6/47 ) respectively in group A vs 21. 1 ( 12/57 ) , 3. 5 (2/57) . 17. 5 % ( 10/57) respectively in group B. Compared to conventional dose regimen, intravenous accelerated streptokinase dose regimen for coronary thrombolysis seems to improve reperfusion rate markedly without increasing adverse events such as bleeding , allergic reaction and hypotension. It suggests that accelerated streptokinase therapy deserves more extensive investigation.

Deep cerebral venous thrombosis in adults

OBJECTIVE: To investigate the pathogenesis, clinical features, radiographic findings and therapeutic outcomes of non-acute intracranial deep venous thrombosis in adults. METHODS: Five patients who presented with increased intracranial pressure were examined with computed tomography, magnetic resonance and angiography, diagnosed as having non-acute intracranial deep venous thrombosis, and treated with thrombolytic therapy. They were reviewed retrospectively. RESULTS: There were 3 men and 2 women, aged from 22 to 49 years. Symptom duration ranged from 1 month to 7 months, and 4 of the 5 patients were associated with venous sinus thrombosis. Two patients developed cold and fever before the onset of disease, and 3 patients had no evident predisposing factors. After the infusion of thrombolytic and systemic anti-coagulant therapy, the neurological symptoms and signs of the patients were alleviated. CONCLUSIONS: Digital subtraction angiography (DSA) is more sensitive and accurate than MRI on diagnosing intracranial deep venous thrombosis. It may play an important role in the assessment of the treatment of intracranial deep venous thrombosis. Thrombolysis and anticoagulation of intracranial deep venous thrombosis appears to be a safe and efficacious treatment not only in the acute stage but also in the non-acute stage.

Atrioventricular block complicating inferior acute myocardial infarction treated with thrombolytic therapy

Objective To investigate the influence and mechanism of incidence of atrioventricular block (AVB) treated with thrombolytic therapy in acute inferior myocardial infarction (AIMI).Methods A total of 46 patients with AIMI were divided into the thrombolytic group (n = 23) and the nonthrornboytic group (n = 23). Intravenous or intracoronary urokinase was given to the former group. We observed the advancing courses of AVB, and further assessed the relationship between occurrence of AVB and stenosis of infarct-related artery (IRA) with coronary angiography.Results Two cases died of Ⅲ o AVB in the non-thrombolytic group, but none was found in the thrombolytic group. The occurrence rate of AVB was similar in both groups; but that of Ⅲ ° AVB was much lower in the thrombolytic group (4 cases) than that in the non-thrombolytic group (11 cases, P ＜ 0.05), and the duration of AVB decreased from 201 ± 113 hours to 102±60 hours after thrombolytic therapy ( P＜0.01 ),which was mainly due to the decrease of AVB in the vanishing interval, but not in the developing interval.The coronary angiography demonstrated that there were an increasing reperfusion flow and a decreasing coronary stenosis of the infarct-related artery after thrombolytic therapy.Conclusion Thrombolytic therapy can reduce the incidence of severe AVB, shorten its duration and decrease the mortality by increasing the coronary reperfusion flow in the patients with AIMI.