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目的 探索动脉内溶栓治疗早期脑梗死的有效方法。方法 纳入3 2例发病6h内的脑梗死病例,采用超选择脑动脉插管,将Tracker 18多孔微导管插入血栓,注入尿激酶溶液1万U/ (ml·min) ,并监测凝血指标。血管开通后,在凝血指标允许的情况下,再追加2 5万U尿激酶。3个月后按改良爱丁堡+斯堪的那维亚评分标准评定疗效,并评定患者总的生活能力和日常生活活动量表(采用巴氏指数)。结果 治疗3个月后疗效评定显示:基本治愈2 3例,显著进步3例,进步2例,总有效率87.5 %。日常生活活动量表显示:独立者2 6例(81.3 % ) ,轻度依赖者2例。脑出血3例(9.4% )。结论 超选择动脉溶栓是治疗早期脑梗死的有效方法,疗效显著,血管再通后继续给予2 5万U尿激酶溶解迁徙的栓子,起到了增强溶栓的作用,其机制可能与防止迁徙性栓塞有关。严格掌握适应证,密切监测凝血指标以及尿激酶最大用量不超过12 5万U是减少脑出血等并发症的重要措施。
Objective To explore an effective method of intra-arterial thrombolysis for early cerebral infarction. Methods Thirty-two cases of cerebral infarction were included in the study. Intracoronary artery cannulation was used to insert the Tracker 18 multi-microcatheter into the thrombus. Urokinase solution was injected to 10,000 U / ml and monitored for coagulation. After the blood vessel is opened, an additional 25,000 U of urokinase will be added when the blood coagulation index allows. Three months later, the efficacy was assessed according to the modified Edinburgh + Scandinavian grading scale and the patient’s total life ability and daily living activity scale (using the Papanicum Index) were assessed. Results After 3 months of treatment, the curative effect evaluation showed that 23 cases were basically cured, 3 cases were significantly improved, 2 cases were improved, and the total effective rate was 87.5%. Daily life activity scale showed: independent 26 cases (81.3%), mild dependence in 2 cases. Intracranial hemorrhage in 3 cases (9.4%). Conclusion Superselective arterial thrombolysis is an effective method for the treatment of early cerebral infarction. The curative effect is remarkable. After recanalization, 25,000 U of urokinase continue to be given to dissolve migratory embolus, which plays an important role in thrombolysis. The mechanism may be related to the prevention of migration Sexual embolism. Strict control of indications, close monitoring of coagulation indicators and the maximum amount of urokinase does not exceed 125,000 U is an important measure to reduce complications such as cerebral hemorrhage.