摘要
目的探讨尿激酶溶栓治疗风湿性心脏病左心房内血栓脱落致脑栓塞的有效性及安全性。方法8例风湿性心脏病左房室瓣狭窄患者经超声心动图确诊,球囊扩张术前或术中突发意识障碍,口角歪斜,偏瘫,肢体肌力Ⅰ～Ⅳ级,经过颅脑CT排除颅内出血,然后紧急静脉注射尿激酶50万U及静脉滴注50～100万U,3000U肝素钠静脉注射,并续以12500U+0.9%氯化钠溶液50ml微量泵泵入,伴有颅内高压者给予20%甘露醇125ml,或甘油果糖125ml快速静脉滴注,或与呋塞米40mg静脉推注,1次/12h交替使用。结果8例患者均为风湿性心脏病左房室瓣狭窄合并心房纤颤。发病至溶栓治疗时间为1～3h,经过积极溶栓、抗凝及降低颅内压等治疗后,7例患者3～4h后患者意识清楚,血压、呼吸平稳,四肢肌力明显改善,1～7d后四肢肌力完全恢复,口角歪斜症状消失而治愈出院;1例患者显效,即经过溶栓治疗后症状没有完全恢复,但语言表达有所改善,四肢肌力从Ⅰ级增加到Ⅳ级。8例患者未并发颅内和其他部位出血。结论风湿性心脏病左房室瓣狭窄合并心房纤颤患者最好常规行经食管超声检查以排外左心耳内血栓;即使未见血栓,在左房室瓣球囊扩张术前应常规给予尿激酶预防性溶栓(至少1周),如果超声心动图发现心房内血栓,应积极口服华法林抗凝治疗3～6个月,等血栓溶解或机化后才能行左房室瓣球囊扩张术;若患者出现脑栓塞的临床表现,如能排外脑出血,应尽早给予尿激酶溶栓及肝素抗凝,同时积极行降低颅内压等治疗。
Objective To investigate the effectiveness and safety of urokinase thrombolytic therapy for cerebral embolism caused by left atrial thrombosis in patients with rheumatic heart disease. Methods Eight patients with eehoeardiography - confirmed rheumatic mitral stenosis experienced sudden dysfunction of consciousness, mouth asymmetry, hemiparalysis, and I - IV myodynamia before and duration balloon dilatation. After intraeerebral hemorrhage was ruled out by cranial computer tomograpby （CT）, the patients were immediately administered with urokinase （500, 000 IU, iv; 500, 000 - 1, 000, 000 IU, intravenous drip） and heparin （3000 IU, iv）, followed by 12500 IU ＋ normal saline （50ml, pump micro; 2 - 3ml / h）. Patients accompanied with eneephalie high pressure were administered with additional 20% mannitol 125ml, or glycerine fructose 125ml fast intravenous infusion, or intravenous injection of furosemide 40mg used alternately ql2h. Results All these 8 cases of mitral valve rheumatic heart disease were combined with atrial fibrillation. The interval from disease attack to thrombolysis time was 1 - 3 hours. After therapies including active thrombolysis, anticoagulation, and lowering intracranial pressure, satisfactory results were achieved in 7 patients： after 3 - 4 hours, they regained clear consciousness, their blood pressure/breathing returned steady, and their muscle strength of limbs were remarkably increased; after 1 - 7 days, the muscle strength of limbs completely returned normal, the mouth asymmetry disappeared, and all these 7 patients were smoothly discharged. In the remaining one patient, although the symptoms were not fully restored after thrombolytic therapy, the language capability and limb muscle strength were remarkably improved; specifically, the muscle strength of limbs increased from grade I to grade IV. No intracranial hemorrhage or bleeding at other parts of the body was observed in all these 8 patients. Conclusion Urokinase thrombolytic therapy is effective and safe in treating c
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第6期618-619,共2页
Chinese General Practice
关键词
风湿性心脏病
颅内栓塞和血栓形成
溶栓治疗
Rheumatic heart disease
Intracranial embolism and thrombosis
Thrombolytic therapy
