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组织纤维蛋白溶酶原活化剂(Tissue plasminogen activator,-tPA)已被食品与药物管理局应用于治疗急性心肌梗塞(AMI);关于应用t-PA导致出血合并症,包括胃肠道以及腹膜后出血,及中枢神经系统的出血.为了治疗AMI应用t-PA引起并发脑出血(ICA),脑出血性梗塞与硬膜下血肿,其频度为0.0%～1.7%,中枢神经系统出血的发病率与应用t-PA和并用肝素有关,出血的发生机制不明.本文报道1例,女性,60岁应用t-PA治疗AMI,尸检证明在大脑软脑膜及皮层表浅血管有多灶性淀粉性脑血管病(CAA).此例既往体健,无心脏、高血压或脑血管病;因剧烈胸痛证实急性下壁心肌缺血入院,入院前未服用过任何药物,包括阿斯匹林;血压160/100mmHg,神经系统检查正常.发病2.5小时后给予6mgt-PA冲击量,继之第一小时静脉输入54毫克,第二小时予20毫克,次后四小时内每小时予以5毫
Tissue plasminogen activator (tPA) has been used by the Food and Drug Administration for the treatment of acute myocardial infarction (AMI); for bleeding complications associated with t-PA, including gastrointestinal and retroperitoneal Hemorrhage, and central nervous system hemorrhage.For the treatment of AMI with t-PA-induced intracerebral hemorrhage (ICA), cerebral hemorrhagic infarction and subdural hematoma, the frequency of 0.0% to 1.7%, the incidence of central nervous system hemorrhage Rate and the use of heparin and t-PA, the mechanism of bleeding is unknown.This article reports 1 case, female, 60-year-old treatment of AMI with t-PA, autopsy proved in the cerebral parenchyma and cortical superficial blood vessels have multifocal amyloid Cerebrovascular disease (CAA). This case was previously healthy, no heart, high blood pressure, or cerebrovascular disease. Acute inferior myocardial infarction was confirmed by severe chest pain and admitted to hospital without any medication including aspirin. 160 / 100mmHg, normal neurological examination .After onset of 2.5 hours given 6mgt-PA impact, followed by the first hour of intravenous infusion of 54mg, the second hour to 20mg, 4 hours after the next hour to be 5 毫 毫