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1、急性脑梗死溶栓疗法78例临床分析张士森【摘要】目的探讨动脉溶栓与静脉溶栓治疗急性脑梗死(ACI)的有效性与安全性。方法对78例ACI患者随机分两组：①动脉溶栓组28例,应用尿激酶25万〜75万U经股动脉选择性动脉溶栓治疗；②静脉溶栓组50例，应用尿激酶150万U行静脉溶栓治疗。分别于溶栓前、后不同时间进行欧洲卒中量表(ESS)评分,并于溶栓前和溶栓后6h、3d、7d测定凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)，溶栓后24h复查头颅CTo结果①动脉溶栓组溶栓后2h、6h、24h、3dESS评分高于静脉溶栓组(均PV0.05);②
2、动脉溶栓组总有效率为96.43%,残疾率为3.57%;静脉溶栓组总有效率为92.00%,残疾率为8.00%;两组1个月时总有效率相比无显著性差异，但静脉溶栓组致残率(8.00%)明显高于动脉溶栓组(3.57%)(P<0.05);③凝血指标：溶栓后6h、3d、7dTT与PT静脉溶栓组较动脉溶栓组明显延长(均P<0.05),6h、3dFIB明显下降(P<0.05);④动脉溶栓组中梗死灶内岀血4例,静脉溶栓组中脑实质内出血5例。结论动、静脉溶栓治疗ACI均有较好疗效和相对安全性；动脉溶栓显著改善神经功能缺损症状，减轻残疾，早期疗效优于静脉溶栓组。【关键词
3、】急性脑梗死；溶栓疗法；动脉溶栓；静脉溶栓[Abstract]ObjectiveTostudytheefficacyandsafetyofintravenousandintraarterialthrombolytictherapyinacutecerebralinfarction(ACI).Methods78patientswithACIwererandomlydividedintwogroups:intraarterialthrombolyticgroup(n=28)wereintraarteriallyadministedwith250750t
4、housandsunitsurokinasethroughfemoralarteryandintravenousthrombolyticgroup(n=50)wereintravenouslyadministedwith1.5millionunitsurokinase.Beforeandaftertreating,theirneurologicaldeficitscaleswereevaluated・Thethrombintime(TT),prothrombintime(PT)andfibrinogenweredetectedbeforeanda仕
5、erthrombolysis6h,3d,and7d.TheCTscanwasrecheckedafterthrombolysis24h・Results①ESSscaleswerehigherintheintraarterialinfusiongroupthanthoseintheintravenousinfusiongroupat2h,6h,24h,and3d(P<0.05)•②Thetotaleffectiveratesintheintraarterialandintravenousinfusiongroupswere96.43%and92.00
6、%,respectively,whilethedisabilityrateswere3.57%and8.00%,respectively(P<0.01).③PTandTTprolongationaswellasfibrinogenleveldecreaseweremoresignificantintheintravenousinfusiongroupthanthatintheintraarterialinfusiongroup(P<0.05)•④Intracranialhemorrhagiceventsoccurredin4casesofintra
7、arterialinfusionpatientsand5ofintravenousinfusionpatients.ConclusionBothintraarterialandintravenousthrombolytictherapyshowrelativelygoodefficacyandsafety・Intraarterialthrombolysishasmoreadvantagesinearlyimprovementofneurologicaldeficitanddecreaseindisability.【Keywords]acutecer
8、ebralinfarction,thrombolytictherapy,intraarterialandintraveno
