Sloan M A
Arch Neurol. 1987 Jul;44(7):748-68. doi: 10.1001/archneur.1987.00520190052017.
Investigators have tried to limit ischemic cerebral infarct size by pharmacologic and surgical means with mixed results. Thrombolytic (fibrinolytic) therapy has been used in the past with unfavorable outcome. With advances in clinical and radiologic assessment and new knowledge of the pathophysiology of brain ischemia, thrombolytic therapy has now become a feasible pharmacologic intervention in acute stroke. Central nervous system hemorrhage, the most dreaded complication of fibrinolytic therapy, is rare in patients with acute myocardial infarction favorably treated with these agents. Risk of hemorrhagic transformation of ischemic cerebral infarcts is related to size, location, and age of patient. Anticoagulation therapy may increase its size, but not its likelihood. The development of clot-specific agents, such as tissue-type plasminogen activator, and careful patient selection make fibrinolytic therapy safe and potentially effective in acute stroke.
研究人员试图通过药物和手术手段来限制缺血性脑梗死的大小，但结果不一。过去曾使用溶栓（纤维蛋白溶解）疗法，但其结果并不理想。随着临床和影像学评估的进展以及对脑缺血病理生理学的新认识，溶栓疗法现已成为急性卒中一种可行的药物干预措施。中枢神经系统出血是纤维蛋白溶解疗法最可怕的并发症，在使用这些药物得到良好治疗的急性心肌梗死患者中很少见。缺血性脑梗死出血性转化的风险与梗死大小、位置及患者年龄有关。抗凝治疗可能会增加梗死大小，但不会增加其发生可能性。诸如组织型纤溶酶原激活剂等血栓特异性药物的研发以及对患者的精心挑选，使得纤维蛋白溶解疗法在急性卒中中既安全又可能有效。
