急性脑梗死患者的局部动脉溶栓治疗.

改善网状结构的功能,利于患者意识恢复和清醒¨o.13]。HBO治疗还可增强吞噬细胞吞噬和消化坏死组织和细胞的能力、加速病灶清除和血肿吸收, 利于组织修复等作用。本研究通过对9个(共包括 3916例患者符合纳入标准的随机对照试验进行系统评价,说明辅用HBO综合治疗可显著提高颅脑损伤患者的总有效率,与郑德群等¨副研究结果一致, HBO治疗还能明显降低颅脑损伤患者的病死率。但本研究中GCS评分和病死率比较的结果分别仅基于2个对照试验,偶然性较大,对这两个结果的参考应持谨慎态度。另外,本研究未对HBO综合治疗的副作用进行评

价,HBO治疗要注意禁忌证和副作用,否则可能会导致不良后果,引起机体损伤。综上所述,辅用HBO进行综合治疗颅脑损伤疗效确切、经济,可以缩短患者的住院时间和降低患者的经济负担,并能提高颅脑损伤患者的生存质量。

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(收稿日期:2008-09.10

急性脑梗死患者的局部动脉溶栓治疗

秦碧勇,席刚明,叶飞,庄凤娟

(郧阳医学院附属人民医院神经内科,十堰442000

・论著・

[摘要]目的观察局部注射尿激酶动脉溶栓治疗急性脑梗死的疗效及并发症。方法对48例发病

于6h内的急性脑梗死患者行动脉内超选择性尿激酶溶栓治疗。其中颈内动脉主干闭塞5例(10.4%,大脑

中动脉主干及分支闭塞36例(75.O%,大脑前动脉闭塞4例(8.3%,椎基底动脉闭塞3例(6.3%。结果

经溶解血栓治疗后完全再通28例(58.3%,部分再通1I例(22.9%,未通9例(18.8%;溶解血栓治疗

后3个月疗效良好的患者33例,疗效差者15例;39例溶通患者中疗效良好者31例(79.5%,9例未溶通患

者中疗效良好者2例(22.2%;溶栓后脑出血ll例(22.9%。结论局部动脉溶栓治

疗能明显提高血管再

通率,明显改善预后,是治疗急性脑梗死的一种有效的方法。

[关键词]脑梗死;血栓溶解疗法;尿纤溶酶原激活物;输注,动脉内

[中图分类号]R743.33[文献标识码]A 【文章编号]1672-6790(200906-0595-03

作者简介:秦碧勇,主治医师,E-mail:beyond@y@163.corn

・596・生凰蝤鏖堡熊垫蠢!Q塑生!!旦筻!!鲞麓!塑璺!i!!璺!堕旦!!缝她:望竺!翼缝!!Q嫂:∑!!:!兰:盥Q:!

Local intra・arterial thrombolysis in acute cerebral infarction QIN Bi-yong l XI Gang-ruing,YE Fei,ZHUANG

Feng-juan(Department ofNeurology,t船Affiliated People’S Hospital,Yunyang Medical College,Shiyan 442000,Chi-

,m

【A按建|雠l】Objective To observe the efficacy and complication of local intra—arterial thrombolysis(LITU—

sing

umkin鹊e in patients with acute cerebral infaretion.Methods 48patients with acute cerebral infarction within

6h from onset were treated with intra.arterial thrombolysis using umkin鹊e.The locations of occlusion included of 5in.

ternal carotid artery(ICA,36of middle cerebral artery(MCA,4of anterior cerebral artery(ACAand 3of the

posterior circulation.Results Complete

recanalization after thrombolysis were observed in 28of the 48patients

(58.3%,partial recanalization in 11of the 48patients(22.9%,no recanalization in 9of the 48patients

(18.8%.The clinical outcome 3months after thrombolysis Wilt8evaluated according to MRS score。33patients were

good outcome(MRS SCOTe《2and 15patients were poor outcome(MRS

score≥3.39of the霹8patients

(79.5%of complete/partial recanalization were good outcome,only 2of the

9patients(22.2%of no reeanaliza・

tion were good outcome.Cerebral hemorrhages occurred in 11patients(22,9%after thrombolysis.Conclusion LIT

using urokinase earl apparently impmve the rate of reeanalization and clinical outcome。It is鞴effective and

relatively