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目的探讨小剂量rt-PA静脉溶栓治疗3 h内脑梗死的临床疗效及并发症。方法2006年1月至2007年10月对急诊接治发病3 h内的急性脑梗死患者32例给予0.6 mg/kg(最大50 mg)rt-PA静脉溶栓治疗。结果急性脑梗死3 h内静脉溶栓率为3.7%,静脉溶栓再通率为65.6%,再通时间(37±27)min,再通时肌力迅速恢复Ⅴ-~Ⅴ级,语言障碍明显改善,但神经系统症状完全恢复仍需一段时间。再通后发生再闭塞4.8%,轻微出血9.3%,未发生脑出血现象,溶栓再通与未通组在治愈、有效、无效、死亡方面比较差异有统计学意义(P<0.01)。溶栓患者4周内治愈59.4%、显效15.6%、无效12.5%、病死率12.5%。结论3 h内给予0.6 mg/kg(最大50 mg)rt-PA静脉溶栓治疗是安全有效的,由于溶栓的时间窗窄及溶栓禁忌证的限制,溶栓治疗的比例很小。必须提高高危人群对脑梗死症状的认识,一旦出现脑血管疾病的症状及时就诊、早期诊断、早期溶栓治疗,有效地改善预后。同时应注意到小剂量rt-PA静脉溶栓的并发症少,但再通率低这一现象,因此应进一步探讨rt-PA最佳的静脉溶栓剂量,以取得最大的再通率及最少的并发症。
Objective To investigate the clinical efficacy and complications of intravenous thrombolysis with rt-PA for 3 h after cerebral infarction. Methods From January 2006 to October 2007, 32 patients with acute cerebral infarction within 3 hours after emergency treatment were given 0.6 mg / kg rt-PA intravenous thrombolysis (maximum 50 mg). Results Intravenous thrombolysis rate was 3.7% within 3 h after acute cerebral infarction, 65.6% after intravenous thrombolysis, and then recanalized for 37 ± 27 min. Significant improvement, but the complete recovery of nervous system symptoms still take some time. After recanalization, reocclusion occurred 4.8% and mild bleeding 9.3%. No cerebral hemorrhage occurred. There was significant difference in the cure, effective, ineffectiveness and death between thrombolysis recanalization and failed group (P <0.01). Thrombolytic patients within 4 weeks cured 59.4%, markedly effective 15.6%, 12.5% ineffective, mortality 12.5%. Conclusion Intravenous thrombolysis with 0.6 mg / kg (up to 50 mg) of rt-PA within 3 h was safe and effective. Thrombolytic therapy was minimal due to the narrow time window of thrombolysis and restrictions on thrombolysis contraindications. We must raise the risk of cerebral infarction in high-risk groups, once the symptoms of cerebrovascular disease timely treatment, early diagnosis, early thrombolytic therapy, effectively improve the prognosis. At the same time, it should be noted that low dose rt-PA intravenous thrombolytic complications less, but the phenomenon of low pass rate, it should further explore rt-PA best intravenous thrombolytic dose, in order to obtain the maximum recanalization rate and the least Complications.