急性缺血性脑血管病选择性动脉溶栓治疗
吉林大学第一医院缺血性脑血管病介入治疗中心 (130021)
【摘要】
目的：探讨急性缺血性脑血管病选择性动脉溶栓治疗的最佳治疗时机和影响治疗效果的各种因素，以期提高动脉溶栓疗效，减少并发症。
方法：对我科2004年2月～8月行选择性动脉溶栓治疗的28例急性缺血性脑血管病患者临床资料的进行总结。一般资料：男17例、女11例，年龄37～76岁，平均年龄57.9岁，合并高血压19例，糖尿病8例，心脏病14例，真性红细胞增多症1例。发病3h之内6例，3～6h 18例，6～10h 4例。ICA缺血症状15例：所有患者均有明显瘫痪，肌力0～2级，伴有意识障碍6例，失语4例，感觉障碍6例，病理反射15例；VBA缺血症状13例：肌力3级以下10例，4级2例；伴有意识障碍12例，眩晕、复视或共济失调11例，构音障碍9例，感觉障碍7例，双侧病理反射13例。
, 百拇医药
结果：① 造影结果 颈内动脉系统15例：完全闭塞12例，溶栓后10例再通(3例完全再通，7例残余狭窄，其中2例同时行狭窄动脉血管内支架成型术后完全再通)，2例未通；未见明显异常3例，考虑深穿支闭塞。椎-基底动脉系统13例：完全闭塞7例，溶栓后5例再通(2例完全再通，3例残余狭窄)，2例未通；严重狭窄3例，溶栓后部分缓解；未见明显异常3例，考虑深穿支闭塞。② 临床结果 颈内动脉系统15例：痊愈6例(40%)、显效1例(6.7%)、有效7例(66.7%)、无效0、死亡1例(6.7%)；椎-基底动脉系统13例：痊愈3例(23.1%)、显效2例(15.4%)、有效3例(23.1%)、无效1例(6.7%)、死亡4例(30.8%)。③ 并发症：颅内出血2例，其中1例好转，1例无效，无死亡。无栓塞、心梗及动脉夹层等手术并发症。
结论 ：严格按照适应证选择病例，严格遵循介入手术操作规范行急性期动脉溶栓治疗是比较安全的；与静脉溶栓相比，术前动脉造影可明确脑血管病的病因，准确判断是否适合溶栓治疗；而且动脉溶栓能明显增加局部溶栓药物浓度，提高治疗效果，减少溶栓药物用量，降低出血并发症；同时对残留明显狭窄血管可行血管内支架成型治疗，并能指导进一步治疗及判断预后。
, 百拇医药
Selective Intra-arterial Thrombolysis for Acute Ischemic Stroke
WANG Shouchun, WU Jiang, WANG Dawei, FENG Jiachun,FANG Shaokuan, RAO Mingli
Interventional treatment center for ischemic stroke,first hospital of Norman Bathune College of Medical Sciences, Jilin University
【Abstract】
Objective：To explore the best occasio of selective intra-arterial treatment for acute ischemic stroke and analyze the effect factors for curative effect, in the hope of improving the effect and reducing complications of the treatment.
, 百拇医药
Methods：Clinical data of 28 cases in Department of Neurology of our hospital during Feb. - Aug. 2004 who suffered from acute ischemic stroke and accepted selective intra-arterial thrombolysis were analyzed retrospectively. Composed of 17 male and 11 female, the cases aged from 37 to 76, with the mean of 57.9. Among them, there were 19 cases with hypertension, 8 with diabetes mellitus, 14 with cardiac diseases and 1 with polycythemia rubra vera. The intervals from onset to thrombolysis of the cases were as follows: 6 cases, <3h; 18 cases, 3-6h and 4 cases, 6-10h. 15 ones showed the signs of ischemia of internal carotid artery (ICA): all of them, obvious paralysis with muscle strength level of 0-2; 6 cases, conscious disturbance; 4 cases, aphasia; 6 cases, sensory disturbance and 15 cases, pathologic reflex. While, 13 ones showed the signs of ischemia in vertebrobasilar artery (VBA): 10 cases, muscle strength level≤3 and 2 cases, level 4; 12 cases, conscious disturbance; 11 cases, vertigo, diplopia or dystaxia; 9 cases, dysarthria; 7 cases, sensory disturbance and 13 cases, bilateral pathologic reflex.
, 百拇医药
Results： (1) Arterial agiography results 15 cases accepted angiography in ICA system. Among them, 12 ones showed complete occlusion and 3 ones showed no obvious disorder (penetrating arteries occlusion, maybe). After intra-arterial thrombolysis, 10 of the 12 cases had arterial recanalization (3 ones had complete recanalization; 7 ones still had stenosis and with the help of stent angioplasty, 2 of them gained complete recanalization), while the other 2 cases failed to recanalize. 13 cases accepted angiography in VBA system. Among them, 7 ones showed complete occlusion (after thrombolysis, 5 of the 7 cases gained recanalization (2 with complete and 3 with incomplete recanalization)and the other 2 cases failed ), 3 showed serious stenosis (partial improved after thrombolysis) and another 3 showed no obvious disorders (penetrating arteries occlusion, maybe). (2) Curative effects Among the 15 ones accepting thrombolysis in ICA system, 6 cases recovered (40%), 1 case had significant improvement (6.7%), 7 cases had improvement (46.7%) and 1 case died (6.7%). While, among the 13 ones accepting thrombolysis in VBA system, 3 cases recovered (23.1%), 2 cases had significant improvement (15.4%), 3 cases had improvement (23.1%), 1 cases had no effect (7.7%) and 4 cases died (30.8%). (3) Complications 2 cases suffered from intracranial hemorrhage, 1 had improvement after treatment and the other showed no signs. Other complications, such as embolism, myocardial infarction and dissecting aneurysm, were not found.
, 百拇医药
Conclusion: If doctors can choose cases carefully according to indications and operate strictly on interventional standard, intra-arterial thrombolysis is a relatively safe theraputic approach. Compared to intravenous thrombolysis, angiography before thrombolysis can help doctors find the etiological factors for stroke, and thereby make better judgements on theraputic strategy. Intra-arterial thrombolysis can increase the local concentration and effect of thrombolytic agents, reduse the dosage of thrombolytic agents and complications provide convenience for using stent angioplasty in serious stenosis and help to direct subsequent treatment strategy and judge prognosis., 百拇医药(王守春 吴江 王大伟 冯加纯 房绍宽 饶明俐)
【摘要】
目的：探讨急性缺血性脑血管病选择性动脉溶栓治疗的最佳治疗时机和影响治疗效果的各种因素，以期提高动脉溶栓疗效，减少并发症。
方法：对我科2004年2月～8月行选择性动脉溶栓治疗的28例急性缺血性脑血管病患者临床资料的进行总结。一般资料：男17例、女11例，年龄37～76岁，平均年龄57.9岁，合并高血压19例，糖尿病8例，心脏病14例，真性红细胞增多症1例。发病3h之内6例，3～6h 18例，6～10h 4例。ICA缺血症状15例：所有患者均有明显瘫痪，肌力0～2级，伴有意识障碍6例，失语4例，感觉障碍6例，病理反射15例；VBA缺血症状13例：肌力3级以下10例，4级2例；伴有意识障碍12例，眩晕、复视或共济失调11例，构音障碍9例，感觉障碍7例，双侧病理反射13例。
, 百拇医药
结果：① 造影结果 颈内动脉系统15例：完全闭塞12例，溶栓后10例再通(3例完全再通，7例残余狭窄，其中2例同时行狭窄动脉血管内支架成型术后完全再通)，2例未通；未见明显异常3例，考虑深穿支闭塞。椎-基底动脉系统13例：完全闭塞7例，溶栓后5例再通(2例完全再通，3例残余狭窄)，2例未通；严重狭窄3例，溶栓后部分缓解；未见明显异常3例，考虑深穿支闭塞。② 临床结果 颈内动脉系统15例：痊愈6例(40%)、显效1例(6.7%)、有效7例(66.7%)、无效0、死亡1例(6.7%)；椎-基底动脉系统13例：痊愈3例(23.1%)、显效2例(15.4%)、有效3例(23.1%)、无效1例(6.7%)、死亡4例(30.8%)。③ 并发症：颅内出血2例，其中1例好转，1例无效，无死亡。无栓塞、心梗及动脉夹层等手术并发症。
结论 ：严格按照适应证选择病例，严格遵循介入手术操作规范行急性期动脉溶栓治疗是比较安全的；与静脉溶栓相比，术前动脉造影可明确脑血管病的病因，准确判断是否适合溶栓治疗；而且动脉溶栓能明显增加局部溶栓药物浓度，提高治疗效果，减少溶栓药物用量，降低出血并发症；同时对残留明显狭窄血管可行血管内支架成型治疗，并能指导进一步治疗及判断预后。
, 百拇医药
Selective Intra-arterial Thrombolysis for Acute Ischemic Stroke
WANG Shouchun, WU Jiang, WANG Dawei, FENG Jiachun,FANG Shaokuan, RAO Mingli
Interventional treatment center for ischemic stroke,first hospital of Norman Bathune College of Medical Sciences, Jilin University
【Abstract】
Objective：To explore the best occasio of selective intra-arterial treatment for acute ischemic stroke and analyze the effect factors for curative effect, in the hope of improving the effect and reducing complications of the treatment.
, 百拇医药
Methods：Clinical data of 28 cases in Department of Neurology of our hospital during Feb. - Aug. 2004 who suffered from acute ischemic stroke and accepted selective intra-arterial thrombolysis were analyzed retrospectively. Composed of 17 male and 11 female, the cases aged from 37 to 76, with the mean of 57.9. Among them, there were 19 cases with hypertension, 8 with diabetes mellitus, 14 with cardiac diseases and 1 with polycythemia rubra vera. The intervals from onset to thrombolysis of the cases were as follows: 6 cases, <3h; 18 cases, 3-6h and 4 cases, 6-10h. 15 ones showed the signs of ischemia of internal carotid artery (ICA): all of them, obvious paralysis with muscle strength level of 0-2; 6 cases, conscious disturbance; 4 cases, aphasia; 6 cases, sensory disturbance and 15 cases, pathologic reflex. While, 13 ones showed the signs of ischemia in vertebrobasilar artery (VBA): 10 cases, muscle strength level≤3 and 2 cases, level 4; 12 cases, conscious disturbance; 11 cases, vertigo, diplopia or dystaxia; 9 cases, dysarthria; 7 cases, sensory disturbance and 13 cases, bilateral pathologic reflex.
, 百拇医药
Results： (1) Arterial agiography results 15 cases accepted angiography in ICA system. Among them, 12 ones showed complete occlusion and 3 ones showed no obvious disorder (penetrating arteries occlusion, maybe). After intra-arterial thrombolysis, 10 of the 12 cases had arterial recanalization (3 ones had complete recanalization; 7 ones still had stenosis and with the help of stent angioplasty, 2 of them gained complete recanalization), while the other 2 cases failed to recanalize. 13 cases accepted angiography in VBA system. Among them, 7 ones showed complete occlusion (after thrombolysis, 5 of the 7 cases gained recanalization (2 with complete and 3 with incomplete recanalization)and the other 2 cases failed ), 3 showed serious stenosis (partial improved after thrombolysis) and another 3 showed no obvious disorders (penetrating arteries occlusion, maybe). (2) Curative effects Among the 15 ones accepting thrombolysis in ICA system, 6 cases recovered (40%), 1 case had significant improvement (6.7%), 7 cases had improvement (46.7%) and 1 case died (6.7%). While, among the 13 ones accepting thrombolysis in VBA system, 3 cases recovered (23.1%), 2 cases had significant improvement (15.4%), 3 cases had improvement (23.1%), 1 cases had no effect (7.7%) and 4 cases died (30.8%). (3) Complications 2 cases suffered from intracranial hemorrhage, 1 had improvement after treatment and the other showed no signs. Other complications, such as embolism, myocardial infarction and dissecting aneurysm, were not found.
, 百拇医药
Conclusion: If doctors can choose cases carefully according to indications and operate strictly on interventional standard, intra-arterial thrombolysis is a relatively safe theraputic approach. Compared to intravenous thrombolysis, angiography before thrombolysis can help doctors find the etiological factors for stroke, and thereby make better judgements on theraputic strategy. Intra-arterial thrombolysis can increase the local concentration and effect of thrombolytic agents, reduse the dosage of thrombolytic agents and complications provide convenience for using stent angioplasty in serious stenosis and help to direct subsequent treatment strategy and judge prognosis., 百拇医药(王守春 吴江 王大伟 冯加纯 房绍宽 饶明俐)