Yusuf S W, Whitaker S C, Gregson R H, Wenham P W, Hopkinson B R, Makin G S
Department of Vascular Surgery, University Hospital Nottingham, UK.
Br J Surg. 1995 Mar;82(3):338-40. doi: 10.1002/bjs.1800820318.
Pulse spray thrombolysis is a technique of accelerated peripheral thrombolysis which has been evaluated in 38 patients, 29 with threatened limb viability and nine with a viable but critically ischaemic limb. The median length of occlusion was 26.5 (range 3-65) cm. The lytic agent used was recombinant tissue plasminogen activator (rtPA), injected manually via a pulse spray catheter at a concentration of 0.33 mg/ml and a bolus size of 0.2 ml. The median total dose of rtPA was 18 (range 5-35)mg. Patency and flow were completely restored in 34 of 38 patients and clinical success at 30 days was maintained in 27 of 38. The median lysis time was 120 (range 35-1125) min, compared with a median duration of 1545 (range 42-5760) min in 120 consecutive patients previously treated with conventional low-dose infusion thrombolysis using rtPA. This represents a 12-fold reduction in lysis time (P < 0.001). The overall estimated cumulative limb salvage rate for the 38 patients who entered the study was 84 per cent and the cumulative patency rate for the 34 patients in whom patency was restored was 74 per cent at 18 months follow-up. Pulse spray thrombolysis rapidly restores patency with good limb salvage at 30 days; the benefit is sustained even in patients with limbs at immediate risk of irreversible ischaemic injury who are not considered suitable for conventional thrombolysis.
脉冲喷射溶栓是一种加速外周溶栓技术，已在38例患者中进行了评估，其中29例肢体存活受到威胁，9例肢体存活但严重缺血。闭塞的中位长度为26.5（范围3 - 65）厘米。使用的溶栓剂是重组组织型纤溶酶原激活剂（rtPA），通过脉冲喷射导管手动注射，浓度为0.33毫克/毫升，推注量为0.2毫升。rtPA的中位总剂量为18（范围5 - 35）毫克。38例患者中有34例的通畅和血流完全恢复，38例中有27例在30天时保持临床成功。中位溶栓时间为120（范围35 - 1125）分钟，相比之下，之前连续120例使用rtPA进行传统低剂量输注溶栓治疗的患者，中位持续时间为1545（范围42 - 5760）分钟。这意味着溶栓时间缩短了12倍（P < 0.001）。进入研究的38例患者的总体估计累积肢体挽救率为84%，在18个月的随访中，34例恢复通畅的患者的累积通畅率为74%。脉冲喷射溶栓可迅速恢复通畅，30天时肢体挽救效果良好；即使对于那些被认为不适合传统溶栓治疗、肢体有立即发生不可逆缺血性损伤风险的患者，这种益处也能持续存在。
