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使用溶栓剂重建血流治疗急性脑缺血尚处于研究阶段。许多前瞻性多中心试验指出了静脉或动脉输注使脑动脉再通的可行性。最近报告的以血管造影术为基础的,静脉输注重组组织纤溶酶原激活剂(rt-PA)疗效的研究表明,rt-PA(duteplase)的血管再通与剂量率无明显关系,早期治疗可使30天时血管再通和神经功能后果获得改善。出血性转变及其相关的神经症状加重的发生率并不高于其他研究中未治疗者或文献资料。现有证据证明维持软脑膜侧支循环可能与静脉内输注rt-PA(alteplase)后的良好后果相关。最近一些前瞻性研究的经验将为今后纤溶法治疗急性缺血性卒中的研究提供依据。
The use of thrombolytic agents to reconstruct blood flow for acute cerebral ischemia is still in the research phase. Many prospective multicenter trials have pointed out the feasibility of recanalization of the cerebral arteries by intravenous or arterial infusion. Recent reports of angiography-based studies of the efficacy of intravenous infusion of recombinant tissue plasminogen activator (rt-PA) showed no significant relationship between revascularization and dose rate of rt-PA (duteplase) Treatment improved revascularization and neurological outcome at 30 days. The incidence of hemorrhagic transformation and the associated increase in neurological symptoms were not higher than those in other studies or literature. The available evidence proves that maintaining the pia mater collateral circulation may be related to the good outcome after intravenous infusion of rt-PA (alteplase). Some recent prospective research experience will provide the basis for future fibrinolytic therapy for acute ischemic stroke.