【摘要】　目的　 探討急性腦梗死溶栓治療的療效及安全性。　方法　 2004年1月-2009年5月58例急性腦梗死患者，按接受尿激酶治療時已發病時間分為3組，均接受尿激酶150萬U加生理鹽水150 mL靜脈滴注溶栓治療。分別在治療后0、1、3、9 h進行神經功能評價，1、3、7 d進行神經功能評價及復查頭顱CT。　結果　 發病3 h內與發病3~6 h內溶栓治療效差異無統計學意義（P gt;0.05）；發病3 h內、3~6 h內與發病6~9 h尿激酶溶栓治療療效差異均有統計學意義（P lt;0.05）；發病6~9 h尿激酶溶栓治療療效差，多例并發腦出血，安全性差。　結論　 發病6 h內的腦梗死患者，只要無禁忌證均應盡快行尿激酶溶栓治療；發病6 h后的腦梗死患者，不宜尿激酶溶栓治療；伴房顫者的溶栓治療因樣本量過小研究無意義，有待進一步研究。
【Abstract】　Objective　 To discuss the efficacy and safety of thrombolytic therapy for acute cerebral infarction. 　Methods　 A total of 58 patients with acute cerebral infarction from January 2004 to May 2009 were enrolled in this study. Based on the onset time before accepting urokinase treatment, the patients were divided into three groups. All of them accepted thrombolytic treatment with 1.5 million U of urokinase and 150 ml of saline solution intravenously. Neurological function evaluation was carried out 0, 1, 3, and 9 hours after the treatment. Another neurological function evaluation and skull CT were done 1, 3, and 7 days later, respectively.　Results　 There was no statistical difference between the efficacy of the treatment within 3 hours and between the 3rd hour and the 6th hour after the onset of the disease. However, there was a significant difference between the efficacy within 3 hours and between the 6th and 9th hour, and between the efficacy from the 3rd hour and 6th hour and from the 6th hour and the 9th hour after the onset of the disease. Between the 6th and the 9th hour after the onset, the efficacy and safety were poor with many cases of combined cerebral bleeding.　Conclusions　 For patients within 6 hours after the onset of cerebral infarction, as long as no contraindications exists, thrombolytic therapy should be carried out as soon as possible; 6 hours after the onset, patients should not be treated with thrombolytic therapy. Further study is needed for patients combined with atrial fibrillation due to the small sample size in this study.

Citation： WANG Weiping. Study on the Thrombolysis Effect of Urokinase in Different Time Periods of Acute Cerebral Infarction. West China Medical Journal, 2011, 26(9): 1312-1314. doi: Copy

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