静脉溶栓桥接血管介入治疗急性颅内大动脉闭塞的临床疗效观察：附7例报告  

Clinical observation on intravenous thrombolytic bridging and vascular intervention for treatment of patients with acute intracranial large arterial occlusion： a report of 7 cases

作　　者：高培龙[1] 孙世中[1] 孙洪涛[1] 李建伟[1] 田竺 郝占坡 

机构地区：[1]武警后勤学院附属医院神经外三科,天津300162

出　　处：《中国中西医结合急救杂志》2017年第2期151-154,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：武警后勤学院附属医院种子基金面上项目（FYM201548）

摘　　要：目的评估阿替普酶静脉溶栓联合血管介入治疗急性颅内大动脉闭塞的有效性和安全性。方法回顾性分析2015年7月至2016年8月武警后勤医院附属医院神经外三科住院采用阿替普酶静脉溶栓桥接血管内介入治疗的7例急性颅内大动脉闭塞患者的临床资料，7例患者均采用阿替普酶干粉制剂（每支50mg或20mg），溶剂剂量按0．9mg/kg，最大剂量〈90mg，10％剂量先静脉推注，其余剂量持续静脉微量泵60min注入的方法静脉溶栓，静脉溶栓时或结束后立即进行了数字减影血管造影（DSA）检查，并根据造影结果选择机械取栓、球囊扩张、支架置入3种血管内介入治疗方法至少1项方式，术后24h给予抗血小板聚集药物和钙离子通道拮抗剂，分析介入治疗效果，评估治疗90d的临床预后。结果患者平均年龄（60．0±12．6）岁。7例患者均顺利完成治疗，成功再通[脑梗死溶栓分级（TICI）3级或2b级]者7例（达100％），治疗后美国国立卫生研究院卒中量表（NIHSS）评分较治疗前明显降低（分：5．86±4．10比19．71±5．56，P〈0．01）。90d随访临床结局良好[改良Rankin量表（mRS）评分0～2分]者3例（占42．8％）。结论阿替普酶静脉溶栓桥接血管内介入治疗急性颅内大动脉闭塞能获得良好的再通率。Objective To evaluate the efficacy and safety of using alteplase for intravenous thrombolysis combined with vascular intervention for treatment of patients with acute intracranial large arterial occlusion. Methods Clinical data of 7 patients with acute intracranial large arterial occlusion treated by using aheplase for intravenous thrombolysis combined with intravascular intervention admitted to Department of Neurosurgery in Affiliated Hospital of the Logistics University of Cinese People＇s Armed Police Force from July 2015 to August 2016 were retrospectively analyzed. All the 7 patients were treated by alteplase dry powder （50 mg or 20 mg each ampule）, solvent dose was 0.9 mg/kg, the maximum dose being 〈 90 mg, firstly 10% dose was intravenously injected, and the remaining dose was continuously infused into a vein in 60 minutes, during or after intravenous thrombolysis, digital subtraction angiography （DSA） was performed immediately, and according to the results of the angiography, at least one of the 3 kinds of intravascular mechanical intervention therapy, thrombectomy, balloon dilatation or stent placement, were chosen, and 24 hours after surgery, the anti-platelet aggregation drug and calcium channel antagonists were given, The effect of interventional therapy was analyzed, and the clinical outcome of 90-day treatment was evaluated. Results The mean age of the patients was （60.0 ± 12.6） years. Seven patients all successfully completed the treatment, and satisfactory re-canalization was achieved [they all obtained grade 3 or 2b in accord with the gradation of Thrombolysis in Cerebral Ischemia Scale （TICI）] in all the 7 cases （100%）, after treatment, the National Institutes of Health Stroke Scale （NIHSS） score was significantly lower than that before treatment （5.86±4.10 vs. 19.71 ±5.56, P 〈0.01）. Clinical outcome of 90-day follow up was excellent [Modified Rankin Scale （mRS） score 0 - 2] in 3 cases （42.8%）. Conclusion Using aheplase for intravenous thrombolysis com

关 键 词：阿替普酶 血管介入 颅内大动脉闭塞 

分 类 号：R730.5[医药卫生—肿瘤]