急性缺血性脑卒中的再灌注治疗的现状与未来  

The current status and future directions of reperfusion therapy for acute ischemic stroke

作　　者：乔玥 李传辉[1] 赵文博[1] Qiao Yue;Li Chuanhui;Zhao Wenbo(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《首都医科大学学报》2025年第1期68-70,共3页Journal of Capital Medical University

基　　金：国家自然科学基金项目(82422024);北京市自然科学基金项目(JQ22020)。

摘　　要：静脉溶栓和机械取栓是急性缺血性脑卒中公认有效的再灌注治疗手段,与传统治疗相比其可以显著改善临床预后,但这两种措施仍面临诸多问题和挑战:静脉溶栓虽为首选治疗方案,但血管再通率低、治疗时间窗短(3~4.5 h)制约了其临床获益;而机械取栓即便能实现80%以上的血管再通,但超过50%的患者仍遗留残疾或死亡。基于目前再灌注治疗面临的挑战和国内外研究现状,未来应优化溶栓药物,开发具有更高纤维蛋白特异性和安全性的新型溶栓剂,扩大溶栓治疗获益人群;利用先进影像技术突破传统时间窗限制,实现基于“组织窗”的再灌注治疗;推广移动卒中单元,实现超早期再灌注治疗;优化静脉溶栓治疗后的抗血栓治疗策略,预防神经功能恶化;优化围手术期管理并积极探索神经保护策略,进一步提高机械取栓的疗效。Intravenous thrombolysis and mechanical thrombectomy are well-established reperfusion therapies for acute ischemic stroke,which can significantly improve clinical outcomes compared to conventional treatments.However,both strategies face the following challenges:although it is the first-line treatment,intravenous thrombolysis suffers from low recanalization rates and a narrow therapeutic time window(3-4.5 h),which limits its clinical benefit.Mechanical thrombectomy,while achieving over 80% recanalization,still results in disability or death in more than 50% of patients.Future efforts should focus on optimizing thrombolytic drugs by developing novel agents with higher fibrin specificity and safety profiles,thus expanding the population benefiting from thrombolysis.Moreover,reperfusion therapy based on the“tissue window”could be achieved with utilizing advanced imaging techniques to break the traditional time window limitation.The promotion of mobile stroke units could facilitate ultra-early reperfusion treatment.Additionally,optimization of post-thrombolysis antithrombotic strategies is essential to prevent neurological deterioration.For mechanical thrombectomy,it is crucial to enhance perioperative management and actively explore neuroprotective strategies for further improvement of outcomes.

关 键 词：急性缺血性脑卒中 再灌注治疗 静脉溶栓 机械取栓 移动卒中单元 

分 类 号：R743.3[医药卫生—神经病学与精神病学]