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, U.K.
Eur J Vasc Surg. 1994 May;8(3):270-5. doi: 10.1016/s0950-821x(05)80141-0.
Pulse-spray thrombolysis (PST) is a new technique of accelerated peripheral arterial thrombolysis. This technique has been evaluated on 24 patients with limb ischaemia. Severe acute limb-threatening ischaemia with sensory and motor deficit was present in 11/24 (45.8%) patients. The median dose of recombinant tissue plasminogen activator (rt-PA) used was 18 mg (10-35 mg) injected in a concentration of 0.33 mg/ml and bolus size of 0.2 ml. The median length of occlusions treated was 23 cm (range 4-55 cm). Complete initial lysis was achieved in 23/24 (95.8%) and limb salvage at 30 days was achieved in 18/24 (75%) of the cases. The overall 30-days mortality was 4/24 (16.6%) and 2/4 (50%) in those who required surgical intervention. The median duration of thrombolytic treatment was 137.5 minutes (range 35-1125 minutes) which is an 11-fold and significant reduction (p < 0.001, Mann-Whitney) in lysis time compared with the results of conventional low dose infusion of rt-PA at a rate of 0.5 mg/h in 120 consecutive patients in our unit. PST rapidly restores vascular patency and may become the treatment of choice for acute limb ischaemia including those at immediate risk of irreversible ischaemic injury which would not be considered suitable for conventional thrombolysis.
脉冲喷射溶栓（PST）是一种加速外周动脉溶栓的新技术。该技术已在24例肢体缺血患者中进行了评估。24例患者中有11例（45.8%）存在严重的急性肢体威胁性缺血并伴有感觉和运动功能障碍。使用的重组组织型纤溶酶原激活剂（rt-PA）的中位剂量为18mg（10 - 35mg），以0.33mg/ml的浓度注射，推注量为0.2ml。所治疗的闭塞病变的中位长度为23cm（范围4 - 55cm）。24例中有23例（95.8%）实现了初始完全溶解，24例中有18例（75%）在30天时实现了肢体挽救。总体30天死亡率为24例中的4例（16.6%），在需要手术干预的患者中为4例中的2例（50%）。溶栓治疗的中位持续时间为137.5分钟（范围35 - 1125分钟），与我们单位连续120例以0.5mg/h的速率进行传统低剂量rt-PA输注的结果相比，溶解时间缩短了11倍且具有显著差异（p < 0.001，曼 - 惠特尼检验）。PST能迅速恢复血管通畅，可能成为急性肢体缺血治疗的首选方法，包括那些有立即发生不可逆缺血损伤风险且不适合传统溶栓治疗的患者。
