| Acute cerebral infarction is a frequent disease for nervous system, with high mortality and deformity. To search an effective treatment is especially important. Thrombolytic therapy is the most promising treatment of acute ischemic stroke, one of the most promising approaches. The infarction area cerebral blood flow can be quickly restored and achieve early reperfusion for cerebrovascular, So focal cerebral ischemia caused by the easing of symptoms and signs of neurofunctional defect. Intra-arterial thrombolysis is very good in small in dosage, high thrombus local drug concentration, high recanalization rate, curative effect. But due to the intracerebral hemorrhage and ischemia-reperfusion injury and re-occlusion complications occurred in thrombolytic therapy. So to choice optimal thombolysis plan and optimal thrombolysis time and optimal route of administration and perfect thrombolysis drug has became the theme of thrombolytic therapy in a current world. The purpose of this study was to investigate the clinical effects, security and prognostic factors in superselected intra-arterial thrombolysis with urokinase for acute cerebral infarction; to observe treatment of value in super-early intra-artery thrombolysis with Xenon-CT for diagnosis and treatment. 120 patients with acute cerebral infarction in 6 hours (vertebrobasilar system within 10 hours) were divided into two groups, arterial thrombolysis group (60 cases) and control group (60 cases).Using seldinger's technique to cerebral angiography by femoral catheterization, will catheter into the brain vascular occlusion site, with the injection pump inject urokinase for arterial thrombolytic therapy. The control group patients with ischemic cerebrovascular disease for neurology routine therapy.The results show that there are 43 cases finded by DSA before thrombolysis, 24 inner carotid arteries were occluded, 17vascular recanalization after thrombolysis, 9 vascular recanalization completely, 8 partially, 7 none, recanalization rate is 70.8%; 19 vertebro - basilar artery were occluded, 11 vascular recanalization after thrombolysis, 7 vascular recanalization completely, 4 partially, 8 none, recanalization rate is 57.9%. The ESS score of thrombolysis groups after treatment 2h,24h,7d,14d are higher than before treatment (P<0.01);the ESS score of after treatment 2h,24h,7d,14d are higher than control group (P<0.05 or P<0.01). The efficiency rate and the tatal effective rate of thrombolysis groups after treatment 24h,14d are higher than control group (P<0.01). The clinical evaluation show that Barthel Index (BI) score of thrombolysis groups are higher than control group (P<0.01). The clinical evaluation show that the efficiency rate and the tatal effective rate are uniformity in three groups (P>0.05). The systolic blood pressure after intra - arterial theombolytic therapy 12h are lower than no-reperfusion groups (P<0.05). 3 intracranial hemorrhage, 1 acute upper gastrointestinal bleeding in thrombolysis groups. 8 died in thrombolysis groups, 12 died in control groups.So, The arterial thrombolysis compare with medicine methods therapy for acute cerebral infarction is a safe and effective way to significantly improve the patient's quality of life; urokinase is a relatively safe thrombolycic agent; Xenon-CT perfusion imaging technique is an effective way what rapid and accurate determination of the ischemic penumbra, has provided a reliable objective evidence for individual choice in thrombolytic therapy. Xenon-CT examination held before thrombolytic therapy programs help clinicians determine the scope and extent of ischemic tissue. Ischemia detection of acute ischemic cerebrovascular disease ultra-early treatment to determine the time window. To provide a positive assessment is great value of thrombolytic therapy. Therefore, we can come to the view that Xenon-CT technology is the future of thrombolytic therapy in the treatment of a predefined time windows and the main direction of development.
|
PDF Full Text Request