动脉内溶栓治疗急性缺血性脑梗死  

Intra-artery thrombolytic therapy for acute ischemic cerebral infarction

作　　者：杜伟[1] 邵成民[1] 王建林[2] 雷进[2] 贾帆[2] 曹兰芳[2] 柴汝昌[1] 苏伟[1] 顾进川[1] 

机构地区：[1]云南省第二人民医院放射科,昆明650021 [2]云南省第二人民医院神经内科,昆明650021

出　　处：《介入放射学杂志》2004年第3期231-233,共3页Journal of Interventional Radiology

摘　　要：目的　观察动脉内溶栓治疗急性缺血性脑梗死的临床效果 ,并分析影响预后的因素。方法　对 32例发病在 2～ 2 0h内的急性缺血性脑梗死患者进行动脉内溶栓治疗。尿激酶平均用量 6 5万U。患者病情在入院时由神经科医师以美国国立卫生研究院卒中分数 (NIHSS)综合评分。临床结果评价在溶栓后 3个月进行 ,按改良的Rakin分数 (MRS)分为好结果 (MRS 0～ 3)、差结果 (MRS 4～ 6 )两类。结果　灌注溶栓治疗后脑血管造影复查 ,闭塞血管再通率达 6 2 .5 % ,其中闭塞时间 6h内的 1 4例中 ,部分或完全再通 1 3例 ,闭塞时间在 6～ 2 0h的 1 8例中 ,部分或完全再通 7例。 2 0例患者 (6 2 .5 % )为好结果 ,1 2例 (37.5 % )为差结果 ,其中 2例死亡。 2例 (6 .2 5 % )发生症状性脑出血。良好的预后与入院时NIHSS评分 <2 0 (P <0 .0 1 )及血管再通 (P <0 .0 2 5 )密切相关 ,而血管再通又与开始溶栓时间 <6h有关 (P <0 .0 5 )。结论　动脉内溶栓治疗急性缺血性脑梗死是一种安全有效的方法 ,可使大部分患者闭塞动脉再通 ,提高临床治疗效果。血管闭塞时间越短 。Objective To evaluate the clinical effects of intra arterial thrombolytic therapy for acute ischemic cerebral infarction and analize the factors influencing the clinical prognosis. Methods 32 patients were treated with intra arterial thrombolysis using urokinase(median dose, 65×10 4 U) within 2～20 hours, after the onset. The patient's condition was assessed by neurologists using National Institutes of Health Stroke Scale(NIHSS) score right at the admission. Clinical outcome was assessed after 3 months and graded as good for Modified Rankin Scale(MRS) scores of 0 to 3 and poor for MRS scores of 4 or 5 and death. Results Follow up cerebral angiography of 14 cases treated within 6 hours after onset showed complete/partial recanalization in 13 cases. Other 18 patients whose treatment started beyond 6 hours after onset outcame with complete/partial in 7. 20(62.5%) of the 32 patients had good outcome, 12(37.5%) had poor outcome and two patients(9.4%) died. Cerebral hemorrhage occurred in 2 of the 32 patients. Good outcome was associated with an initial NIHSS score of <20 ( P <0.01) and vascular recanalization( P <0.025). Recanalization was more likely to be obtained if thrombolysis began within 6 hours ( P <0.05).Conclusion Intra arterial thrombolysis is a safe and effective therapy for acute ischemic cerebral infarction.

关 键 词：动脉内溶栓 溶栓治疗 急性缺血性脑梗死 介入治疗 脑血管病 

分 类 号：R743.33[医药卫生—神经病学与精神病学]