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目的 :观察急性脑梗塞 96小时内介入性溶栓治疗效果及其并发症。方法 :对我院 1996年 10月～ 1997年 10月住院的 17例急性脑梗塞患者于发病 6～ 96小时采用 Selding’s技术 ,经皮穿刺股动脉插管 ,将介入导管置入病变侧颈内动脉 ,然后在导管内缓慢注入尿激酶 (4 0～ 80万 u)或精制蝮蛇抗栓酶 (5 .0 u)。治疗前后分别行 DSA脑血管造影 ,并在治疗前、治疗后 1小时、 2周、一年分别行神经功能评定。结果 :血管完全再通 6例 (35 .3% ) ,部分再通 5例 (2 9.4% ) ,血流量增加6例 (35 .3% )。治疗后 1小时运动改善 14例 ,感觉改善 11例 ,言语改善 6例。 2周临床疗效判定 :基本痊愈 3例 (17.6 % ) ,显著进步 11例 (6 4.8% ) ,进步 3例 (17.6 % )。一年后随访 16例 ,其中基本痊愈 8例 (5 0 % ) ,显著进步 8例 (5 0 % )。并发症 :脑出血 1例 ,血管再闭塞 1例。结论 :急性脑梗塞介入性溶栓治疗针对性强 ,局部溶栓药物浓度高 ,血管再通率高。即使是发病 96小时内溶栓治疗效果亦显著。只要严格掌握适应症 ,术中、术后严密观察 ,即可减少或避免并发症的发生。
Objective: To observe the effect of interventional thrombolysis and its complications within 96 hours after acute cerebral infarction. Methods: Seventeen patients with acute cerebral infarction who were hospitalized from October 1996 to October 1997 in our hospital were treated with Selding’s technique for 6 to 96 hours. Percutaneous puncture of the femoral artery was performed. The interventional catheter was placed into the lesion side internal carotid artery , Followed by slow infusion of urokinase (40 to 80 000 u) or purified viper antithrombin (5.0 u) in the catheter. DSA cerebrovascular angiography was performed before and after treatment, and neurological function was assessed before treatment, 1 hour, 2 weeks and 1 year after treatment. Results: Complete recanalization in 6 cases (35.3%), partial recanalization in 5 cases (2 9.4%), and blood flow increase in 6 cases (35.3%). One hour after treatment, the exercise improved in 14 cases, sensory improvement in 11 cases, speech improvement in 6 cases. After 2 weeks, the clinical curative effect was evaluated: 3 cases (17.6%) were basically cured, 11 cases (6 4.8%) were significantly improved and 3 cases (17.6%) were improved. One year later, 16 patients were followed up, of which 8 patients were basically cured (50%) and 8 patients (50%) were significantly improved. Complications: 1 case of cerebral hemorrhage and 1 case of vascular occlusion. Conclusion: The interventional thrombolytic therapy in acute cerebral infarction is targeted, the local thrombolytic drug concentration is high and the rate of recanalization is high. Even within 96 hours of onset of thrombolytic effect is also significant. As long as strict indications, intraoperative and postoperative close observation, you can reduce or avoid the occurrence of complications.