急性脑梗死不同时间段尿激酶溶栓的应用

【】　目的　探讨急性脑梗死溶栓治疗的疗效及安全性。　方法　2004年1月-2009年5月58例急性脑梗死患者，按接受尿激酶治疗时已发病时间分为3组，均接受尿激酶150万U加生理盐水150mL静脉滴注溶栓治疗。分别在治疗后0、1、3、9h进行神经功能评价，1、3、7d进行神经功能评价及复查头颅CT。　结果　发病3h内与发病3~6h内溶栓治疗效差异无统计学意义（P>0.05）；发病3h内、3~6h内与发病6~9h尿激酶溶栓治疗疗效差异均有统计学意义（P<0.05）；发病6~9h尿激酶溶栓治疗疗效差，多例并发脑出血，安全性差。　结论　发病6h内的脑梗死患者，只要无禁忌证均应尽快行尿激酶溶栓治疗；发病6h后的脑梗死患者，不宜尿激酶溶栓治疗；伴房颤者的溶栓治疗因样本量过小研究无意义，有待进一步研究。【Abstract】　Objective　Todiscusstheefficacyandsafetyofthrombolytictherapyforacutecerebralinfarction.　Methods　Atotalof58patientswithacutecerebralinfarctionfromJanuary2004toMay2009wereenrolledinthisstudy.Basedontheonsettimebeforeacceptingurokinasetreatment,thepatientsweredividedintothreegroups.Allofthemacceptedthrombolytictreatmentwith1.5millionUofurokinaseand150mlofsalinesolutionintravenously.Neurologicalfunctionevaluationwascarriedout0,1,3,and9hoursafterthetreatment.AnotherneurologicalfunctionevaluationandskullCTweredone1,3,and7dayslater,respectively.　Results　Therewasnostatisticaldifferencebetweentheefficacyofthetreatmentwithin3hoursandbetweenthe3rdhourandthe6thhouraftertheonsetofthedisease.However,therewasasignificantdifferencebetweentheefficacywithin3hoursandbetweenthe6thand9thhour,andbetweentheefficacyfromthe3rdhourand6thhourandfromthe6thhourandthe9thhouraftertheonsetofthedisease.Betweenthe6thandthe9thhouraftertheonset,theefficacyandsafetywerepoorwithmanycasesofcombinedcerebralbleeding.　Conclusions　Forpatientswithin6hoursaftertheonsetofcerebralinfarction,aslongasnocontraindicationsexists,thrombolytictherapyshouldbecarriedoutassoonaspossible;6hoursaftertheonset,patientsshouldnotbetreatedwiththrombolytictherapy.Furtherstudyisneededforpatientscombinedwithatrialfibrillationduetothesmallsamplesizeinthisstudy.