Suwanwela N C, Phanthumchinda K, Suwanwela N, Tantivatana J, Janchai A
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2001 Jun;84 Suppl 1:S428-36.
We studied 9 stroke patients who received a thrombolytic agent at King Chulalongkorn Memorial Hospital. Six presented with stroke in the middle cerebral artery territory and three had basilar stroke. Seven patients were given intravenous thrombolysis and 2 received intra-arterial treatment. We strictly followed the inclusion and exclusion criteria for intravenous tissue plasminogen activator (rt-PA) according to the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA study. For patients receiving intraarterial thrombolysis, emergency angiograms were performed. Two patients with severe basilar stroke dramatically improved after intravenous thrombolysis and had very good outcome. Four patients with middle cerebral artery stroke became worse within 24 hours. Three of them died in the acute phase due to intracerebral hemorrhage (2 cases) and massive infarction with brain herniation (1 case). For intra-arterial treatment, good recanalization was seen but clinical improvement was insignificant. The result of thrombolytic treatment in this study was not so impressive, partly because we only treated the very severe cases. The efficacy of this treatment among our population needs to be further investigated.
我们研究了9名在朱拉隆功国王纪念医院接受溶栓药物治疗的中风患者。6例为大脑中动脉区域中风，3例为基底动脉中风。7例患者接受了静脉溶栓治疗，2例接受了动脉内治疗。我们严格遵循美国国立神经疾病和中风研究所（NINDS）rt-PA研究中静脉注射组织型纤溶酶原激活剂（rt-PA）的纳入和排除标准。对于接受动脉内溶栓治疗的患者，进行了急诊血管造影。2例严重基底动脉中风患者在静脉溶栓后显著改善，预后良好。4例大脑中动脉中风患者在24小时内病情恶化。其中3例在急性期因脑出血（2例）和大面积梗死伴脑疝（1例）死亡。对于动脉内治疗，可见良好的再通，但临床改善不明显。本研究中溶栓治疗的结果并不那么令人印象深刻，部分原因是我们只治疗了非常严重的病例。这种治疗方法在我们研究人群中的疗效需要进一步研究。
