急性脑梗死,静脉溶栓还是选择性动脉溶栓?  

Acute Cerebral Infarction,Intravenous Thrombolysis or Selective Arterial Thrombolysis?

作　　者：张春瑞[1] 杨睿海[1] 李军[1] 

机构地区：[1]陕西省汉中市人民医院心脑血管科,723000

出　　处：《实用心脑肺血管病杂志》2010年第6期757-757,759,共2页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的比较选择性动脉溶栓与静脉溶栓的疗效及安全性,以选择一种最佳的治疗急性脑梗死的途径,降低致残率,改善患者生活质量,减轻家庭及社会负担。方法 60例患者均为我科2006年11月—2009年9月的住院患者,随机分为两组,其中静脉溶栓32例,选择性动脉溶栓28例。(1)静脉溶栓:静脉滴注尿激酶;(2)动脉溶栓:从股动脉插管至血管闭塞部位注射尿激酶。分别于溶栓前、溶栓后2h,1、3、7、14,28d记录美国国立卫生院神经功能缺损评分(NIHSS)。结果动脉溶栓组有效率78.6%,显著有效率57.1%;静脉溶栓组有效率71.9%,显著有效率31.3%;选择性动脉溶栓显著有效率高于静脉溶栓组(P<0.05)。总有效率、脑出血、病死率方面比较无显著差异。结论介入溶栓与静脉溶栓相比,动脉介入溶栓遗留的神经功能缺损更少,疗效更为显著,应当在有手术条件的医院积极推广。Objective Comparison of selective intra-arterial thrombolysis and intravenous thrombolysis efficacy and safety,to select an optimal way of treatment of acute cerebral infarction,reduce disability,improve patient quality of life,reduce the burden on families and society.Methods 60 patients were our department from November 2006 to September 2009 of the hospitalized patients were randomly divided into two groups,of which 32 patients with intravenous thrombolysis,intra-arterial thrombolysis in 28 cases.（1）intravenous thrombolysis：Intravenous infusion of urokinase;（2）Intra-arterial thrombolysis：From the femoral artery to the vascular occlusion site,local injection of urokinase.Respectively,before thrombolysis,after thrombolysis2 hours,1 day,3 days,7 days,14 days,28 days recording the U.S.National Institutes of Health neurological deficit score（NIHSS）.Results Intra-arterial thrombolysis group was 78.6%,significantly effective rate 57.1%;intravenous thrombolysis group was 71.9%,significantly effective rate 31.3%;selective intra-arterial thrombolysis had significantly more efficient than intravenous thrombolysis group（P0.05）.The total effective rate,cerebral hemorrhage,no significant difference in mortality.Conclusion Interventional thrombolysis compared with intravenous thrombolysis,intra-arterial thrombolysis interventional neurological deficit left behind by less,even more significant effect.It should be in a hospital surgical conditions,actively promoted.

关 键 词：溶栓疗法 急性脑梗死 尿激酶 

分 类 号：R743.3[医药卫生—神经病学与精神病学]