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目的 探讨尿激酶静脉溶栓治疗急性脑梗死 (ACI)的适宜剂量和治疗窗掌握的可行性参考指标。方法 对 312例ACI患者按不同的临床亚型、治疗窗及CT所见分组。观察同一时窗不同剂量 ;同一剂量不同的时窗、亚型及有无显示责任梗死灶各组的疗效和出血性转化的相对危险度 (RR)。结果 5万U组疗效明显劣于≥ 10万U各组 (P <0 0 1) ;10、 2 5、 5 0、 10 0万U组间疗效差异无显著性 (P >0 0 5 )。全前循环梗死 (TACI)亚型患者治疗窗为 3～ 6小时和 6～ 12小时组的疗效明显劣于 <3小时组 (P <0 0 5 ) ,且继发出血性梗死 (血肿型 )的RR分别为 <3小时组的 5 1倍和 8 4倍。在 6～ 72小时窗段的部分前循环梗死 (PACI)患者中 ,脑CT尚未显示责任梗死灶组的疗效明显优于已显示组 (P <0 0 1)。结论 尿激酶静脉溶栓的适宜剂量为 10～ 5 0万U ,治疗窗的掌握应亚型化和个体化 ,CT尚未显示责任梗死灶是时窗扩延的重要参考指标。
Objective To investigate the appropriate reference dose of intravenous thrombolytic therapy of urokinase for the treatment of acute cerebral infarction (ACI) Methods 312 cases of ACI patients according to different clinical subtypes, treatment windows and CT grouping. To observe the different doses of the same time window; the same dose of different time windows, subtypes and whether the responsibility of infarction showed the efficacy of each group and the relative risk of hemorrhagic transformation (RR). Results The efficacy of 50,000 U group was significantly worse than that of ≥ 100,000 U groups (P <0.01). There were no significant differences in the efficacy between 10, 25, 50 and 10 000 U groups (P> 0.05). Patients treated with TACI subtype were significantly less effective than those treated with <3 hours (P <0.05) in the treatment window of 3 to 6 hours and 6 to 12 hours, and those with secondary hemorrhagic infarction (hematoma) RRs were 51 times and 84 times <3 hours, respectively. In patients with partial anterior circulation infarction (PACI) of the window of 6 to 72 hours, cerebral CT has not shown any significant effect in the responsible infarction group compared with the previously shown group (P <0.01). Conclusion The optimal dose of intravenous thrombolytic therapy for urokinase is 10-500 000 U. The treatment window should be subtypes and individualized. CT has not shown that the responsible infarction area is an important reference index for time-window extension.