Cejna M, Salomonowitz E, Wohlschlager H, Zwrtek K, Böck R
Ludwig-Boltzmann-Institut für Interventionelle Magnetresonanz, A. ö. Krankenhaus der Landeshauptstadt St. Pölten.
Rofo. 1998 Nov;169(5):521-5. doi: 10.1055/s-2007-1015331.
Assessment of a novel, simple and practical thrombolysis scheme for the purposes of a central hospital.
314 thromboembolic lower extremity occlusions in 260 consecutive patients were treated by thrombolysis as follows: 6 ml rt-PA/h for 30 min; 3 ml rt-PA/h for another 30 min; 1 ml rt-PA/h for 7 hours, and 0.4 ml rt-PA until vessel patency. Antegrade introduction of a 5 F straight end-hole catheter through a 6 F, constantly heparin-flushed sheath, to the level of occlusion was followed by subsequent advancement of the catheter tip according to progress of lysis at time intervals of 2, 4, and 8 hours. The regimen was continued overnight.
82% of arterial occlusions were completely recanalized at the end of thrombolysis. Then, angioplasty was performed if appropriate. Best results (100% recanalization rate) were achieved by treating occlusions of the superficial femoral artery, even in cases of involvement of the entire length of the vessel, and isolated popliteal occlusions. A recanalization rate of 70% was achieved by treating distal crural vessel occlusion. Bypass grafts were recanalized in 50%.
3 x major hematoma, 2 x transluminal perforation; 16 x minor hematoma from the puncture site at the sheath, 4 x erythema, obviously reaction to rt-PA (together n = 25; 8%).
We empirically found and solidly evaluated an effective thrombolysis scheme. Our results demonstrate that major advances are possible even in this well-grounded field.
为一家中心医院评估一种新型、简单且实用的溶栓方案。
对260例连续患者的314例下肢血栓栓塞性闭塞进行如下溶栓治疗：先以6 ml rt-PA/h的速度持续30分钟；再以3 ml rt-PA/h的速度持续30分钟；然后以1 ml rt-PA/h的速度持续7小时，直至血管再通，期间每0.4 ml rt-PA/h持续给药。通过一根5F直头端孔导管经一根持续肝素冲洗的6F鞘管顺行插入至闭塞部位，之后根据溶栓进展情况，在2小时、4小时和8小时的时间间隔推进导管尖端。该方案持续一整夜。
溶栓结束时，82%的动脉闭塞完全再通。然后，视情况进行血管成形术。治疗股浅动脉闭塞时取得了最佳效果（再通率100%），即使血管全程受累及孤立的腘动脉闭塞病例也是如此。治疗小腿远端血管闭塞的再通率为70%。旁路移植血管再通率为50%。
3例严重血肿，2例腔内穿孔；16例鞘管穿刺部位轻微血肿，4例红斑，均为对rt-PA的明显反应（共计25例；8%）。
我们通过经验发现并扎实评估了一种有效的溶栓方案。我们的结果表明，即使在这个基础扎实的领域也可能取得重大进展。
