摘要
目的:探讨动脉内重组组织型纤溶酶原激活物(rtPA)局部溶栓治疗超早期脑梗死的有效性和安全性。方法:收集有完整资料的动脉溶栓病例21例,用NIHSS评分评定溶栓的疗效,用改良Rankin量表评价溶栓治疗90d时的转归,并对溶栓治疗的再通率、有症状脑出血发生率和病死率进行分析。结果:动脉内局部溶栓转归良好的比例为42.9%,有症状脑出血发生率为9.5%,病死率为9.5%。57.1%的溶栓病例完全再通,38.1%的病例部分再通。溶栓后再通等级为Ⅲ级的患者预后良好的比例为58.3%,再通等级为Ⅱ级的患者预后良好的比例为25%。大脑前动脉和大脑中动脉闭塞患者的动脉溶栓后的转归良好,动脉溶栓可降低颈内动脉和基底动脉闭塞的病死率结论:动脉内rtPA局部应用溶栓治疗超早期急性脑梗死安全、有效,再通等级与闭塞部位和预后相关。
Objective： To investigate the effectiveness arid safety of intm-arterial local thrombolysis for hyperacute cerebral infarction with recombinant tissue plasminogen activator （rtPA）. Methods： Twenty-one patients with complete data treated with intra-arterial thrombolysis were collected. National Institutes of Health Stroke Scale （NIHSS） score and the modified Rankin scale evaluated the thrombolytic efficacy and the outcome of thrombolytic therapy at day 90, respectively. The recanalization rate of thromlx^lytic therapy, incidence of symptomatic intracranial hemorrhage and mortality were analyzed. Results： The proportion of good outcome of intra-arterial local thrombolysis was 42.9%, the incidence of symptomatic intracranial hemorrhage was 9.5%, and the mortality was 9.5%. There were 57.1% patients with complete recanalization, and 38.1% patients with partial recanalization. The proportion of good prognosis was 58.3% in patients with recanalization grade Ⅲ after thrombolysis, and the proportion of good prognosis was 25 % in patients with recanalization grade II after thrombolysis. The prognosis was good in patients with anterior cerebral artery and middle cerebral artery occlusions after intra-arterial thrombolysis. Intra-arterial thrombolysis reduced the mortality of internal carotid artery and basilar artery occlusions. Conclusions： Intra-arterial local thrombolysis for hyperacute cerebral infarction with rtPA is relatively safe and effective. The recanalization grades and occlusion sites were associated with the prognosis.
出处
《中华脑血管病杂志（电子版）》
2008年第5期257-261,共5页
Chinese Journal of Cerebrovascular Diseases(Electronic Edition)
关键词
重组组织型纤溶酶原激活物
急性脑梗死
动脉溶栓
recombinant tissue plasminogen activator
cerebral infarction
intra-arterial thrombolysis
