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目的探讨急性缺血性脑卒中动脉内溶栓治疗效果。方法411例急性缺血性脑卒中患者,男238例,女173例,平均为(64±11)岁,发病距接受治疗的时间为2-24 h,采取超选择性接触性溶栓。尿激酶用微量泵以1万u/min持续泵入,总量为80- 130万u。在泵入尿激酶的过程中,通过导引导管造影,了解闭塞血管再通情况。结果颈动脉系统血管闭塞273支,椎-基底动脉系统闭塞132支。脑血管造影未见明显异常78例。颈内动脉闭塞再通率为54.72%;大脑中动脉闭塞再通率为65.18%。大脑中动脉分支闭塞再通率为61.68%。椎-基底动脉系统闭塞再通率为67.42%。并有35例因明显的血管狭窄而给予球囊扩张、支架置入术。临床症状完全恢复正常或有明显好转的247例,为60.10%。结论我们认为动脉内接触性溶栓治疗急性脑梗塞还是很值得进行的。随着溶栓经验的积累,溶栓药的开发,脑保护剂的应用,总有效率会不断提高。
Objective To investigate the effect of intra-arterial thrombolysis in acute ischemic stroke. Methods A total of 411 acute ischemic stroke patients, 238 males and 173 females, with an average of (64 ± 11) years old, were treated with super selective contact thrombolysis for 2-24 hours. Urokinase pump with a small amount of 10,000 u / min pumped continuously, the total amount of 80-130 million u. In the process of pumping urokinase, guide catheter angiography to understand the occlusion of vascular recanalization. Results Carotid artery occlusion of 273 vessels, vertebral - basilar artery occlusion of 132. Cerebral angiography showed no abnormalities in 78 cases. Internal carotid artery occlusion recanalization rate was 54.72%; middle cerebral artery occlusion recanalization rate was 65.18%. The middle cerebral artery occlusion recanalization rate was 61.68%. Vertebrobasilar system occlusion recanalization rate was 67.42%. And 35 cases of balloon dilatation due to obvious vascular stenosis, stent placement. The clinical symptoms were completely recovered or significantly improved in 247 cases, 60.10%. Conclusions We think intra-arterial contact thrombolysis is still worthwhile for acute cerebral infarction. With the accumulation of thrombolytic experience, the development of thrombolytic drugs, the application of brain protective agent, the total efficiency will continue to increase.