动脉溶栓后脑再灌注损伤的临床救治探讨  

Discussion on the treatment of cerebral ischemia-reperfusion injuries following intra-arterial thrombolysis

作　　者：田洪[1] 宋川[1] 范汝雄 周虎传[1] 张玉波[1] 臧巧利[1] 张云泉[1] 刘磊[1] 

机构地区：[1]解放军第324医院神经内科,重庆400020 [2]解放军第324医院放射科,重庆400020

出　　处：《介入放射学杂志》2011年第8期603-605,共3页Journal of Interventional Radiology

摘　　要：目的探讨急性脑梗死动脉溶栓后再灌注损伤的治疗方法。方法回顾件分析解放军第324医院神经内科自2005年10月以来对35例急性脑梗死患者应用尿激酶进行动脉溶栓后出现再灌注损伤的临床资料。结果 33例溶栓后脑血管再通或部分再通,13例(39.4%)继发脑出血,其中2例为脑实质出血,11例为出血性梗死。33例(100%)均有不同程度的脑水肿,其中18例(54.5%)脑中线结构明显移位,意识障碍加重,予以严格血压管控、适时调整脱水药物、加强脑保护及开窗减压等治疗,除1例患者因大量脑出血死亡以外,其余患者均能达到临床好转,神经功能缺损明显减少。结论脑动脉溶栓后均有不同程度再灌注损伤;严格血压管控、适时调整脱水药物、加强脑保护治疗是减轻再灌注损伤的重要方法。Objective To investigate the therapeutic method of cerebral ischemia-reperfusion injuries occurred after arterial thrombolytic therapy for acute cerebral infarction. Methods Thirty-five patients, encountered in authors＂ Department since Oct. 2005, with cerebral ischemia-reperfusion injuries, which occurred after thrombolytic therapy by using arterial perfusion of urokinase for acute cerebral infarction, were enrolled in this study. The clinical data were retrospectively analyzed. Results After the thrombolytic therapy, complete or partial recanalization of the occluded cerebral arteries was obtained in 33 cases, while secondary cerebral hemorrhage occurred in 13 cases, of whom cerebral parenchyma bleeding was seen in 2 and hemorrhagic infarction in 11. Different degrees of cerebral edema were found in all 33 cases. Among them significant shift of the midline structures was detected in 18 （54.5%）, which was manifested clinically as the worsening of disturbance of consciousness. Strict control of blood pressure, prompt adjustment of dehydration medication, strengthening the cerebral protection measures, cerebral decompression by fenestration, etc. were carried out. All the patients took a turn for the better and were out of danger with remarkable improvement of neurological functions except one patient who died from massive intracerebral hemorrhage. Conclusion Usually, different degrees of reperfusion injuries will develop after thrombolytic therapy for cerebral arterial infarction. Strictly controlling blood pressure, promptly adjusting dehydration medication and strengthening cerebral protection are the keys to reduce the severity of cerebral reperfusion injuries.

关 键 词：脑梗死 动脉溶栓 再灌注损伤 救治 

分 类 号：R743.3[医药卫生—神经病学与精神病学]