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目的探讨动静脉联合溶栓治疗急性脑梗死的临床疗效及安全性。方法将36例发病在3h内的超早期脑梗死患者急诊静脉滴注尿激酶1万U/kg,再超选择病变动脉区域灌注尿激酶0.5万U/kg;与同期29例单纯行超选择病变动脉灌注尿激酶(1万U/kg)的超早期脑梗死患者的疗效对比。术前及术后24h、3d、30d采用欧洲卒中量表(ESS)评价神经缺损功能和Barthel指数(BI)评价日常生活能力,观察疗效和不良反应。结果溶栓24h、3d后ESS评分联合组(组Ⅰ)为82±21,87±23;动脉组(组Ⅱ)为77±25,81±24;溶栓后3d、30dBI指数评分联合组为70.8±27.9,81.5±24;动脉组为61.5±21.3,73.0±28.6,治疗后有效率:组Ⅰ为85.7%,组Ⅱ为75.6%,两组比较差异有显著性(P<0.05)。两组分别有3例和2例患者溶栓后CT显示颅内出血征象,无明显差异。结论动静脉联合溶栓治疗急性脑梗死的疗效优于单纯动脉溶栓,安全性相似。
Objective To investigate the clinical efficacy and safety of arteriovenous and thrombolytic therapy for acute cerebral infarction. Methods Thirty-six patients with ultra-early cerebral infarction within 3 hours were treated with intravenous infusion of urokinase 10,000 U / kg and then with urokinase 0.5 million U / kg. In the same period, 29 patients with simple super-selected lesions Comparison of the efficacy of arterial infusion of urokinase (10,000 U / kg) in patients with very early cerebral infarction. The European Stroke Scale (ESS) was used to assess the function of daily life and the Barthel index (BI) before and 24 hours, 3d, 30 days after surgery to evaluate the daily living ability and to observe the curative effect and adverse reactions. Results The arterial group (group Ⅱ) was 77 ± 25,81 ± 24 in ESS score group (group Ⅰ) after thrombolytic therapy for 24h and 3d, and 30dBI index score group 70.8 ± 27.9 and 81.5 ± 24 respectively. The arterial group was 61.5 ± 21.3 and 73.0 ± 28.6. After treatment, the effective rate was 85.7% in group Ⅰ and 75.6% in group Ⅱ. There was significant difference between the two groups (P <0.05). There were no significant differences between the two groups in 3 and 2 patients after thrombolysis CT showed signs of intracranial hemorrhage. Conclusions Arteriovenous thrombolysis combined with thrombolysis is superior to simple arterial thrombolysis in the treatment of acute cerebral infarction. The safety is similar.