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目的探讨急性脑梗塞动脉内溶栓治疗时间及梗塞部位等因素对疗效的影响。方法288例脑梗塞患者均在CT检查及血管造影基础上接受选择性动脉溶栓治疗,其中在6h以内溶栓者76例,6~24h溶栓者212例。统计2组患者的血管再通率和90d后预后情况。结果脑血管造影发现血管闭塞245例,其中颈内动脉系统闭塞173例,椎基底动脉(VBA)闭塞72例;溶栓后再通分别为112例、38例。治疗后90d恢复良好者180例,预后差108例。颅内出血2例。不同治疗时间2组患者治疗后90d预后良好率分别为80.35%和71.43%,血管再通率分别为67.86%和59.26%,血管再通中位时间分别为68min和73min。结论动脉溶栓治疗脑梗塞,动脉内溶栓时间窗与多种因素密切相关。
Objective To investigate the effects of intra-arterial thrombolysis in patients with acute cerebral infarction on infarction location and time. Methods A total of 288 patients with cerebral infarction received selective arterial thrombolysis on the basis of CT and angiography. There were 76 cases of thrombolysis within 6 hours and 212 cases of thrombolysis within 6 to 24 hours. The recanalization rate and the prognosis of the patients in two groups were calculated. Results Cerebral angiography revealed 245 cases of vascular occlusion, of which 173 cases of internal carotid artery occlusion and 72 cases of occlusion of vertebrobasilar artery (VBA). Thrombolytic therapy followed by 112 cases and 38 cases respectively. After 90 days of treatment, 180 cases recovered well, with a poor prognosis of 108 cases. Intracranial hemorrhage in 2 cases. The good prognosis at 90 days after treatment was 80.35% and 71.43% in the two treatment groups. The rates of recanalization were 67.86% and 59.26% respectively. The median time of recanalization was 68 and 73 minutes, respectively. Conclusion Arterial thrombolytic therapy of cerebral infarction, intra-arterial thrombolysis time window and a variety of factors are closely related.