缺血性卒中的溶栓治疗介绍.ppt

溶栓治疗是目前最重要的恢复血流措施之一，重组组织型纤溶酶原激活剂 (rt-PA) 和尿激酶 (UK) 是我国目前使用的主要溶栓药。 国家卫生计生委脑卒中防治工程委员会 脑卒中防治系列指导规范编审委员会.中国急性缺血性脑卒中静脉溶栓指导规范. 2016 Ramee SR, White CJ. Acute Stroke Intervention. Curr Probl Cardiol 2014;39:59–76 使用方法：rtPA 0.9 mg／kg(最大剂量为90 mg)静脉滴注，其中10％在最初1 min内静脉推注，其余持续滴注1 h，用药期间及用药24 h内应严密监护患者(见表5)(I级推荐，A级证据)。 溶栓药物剂量 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014.中华神经科杂志 2015；48（4）：246-257 小剂量 vs 标准剂量 入选患者来自中国急性缺血性卒中溶栓监测登记研究（Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China，TIMS-China）。 TIMS-China是一个前瞻性、多中心、急性缺血性卒中静脉溶栓监测登记研究，自2007年5月至2012年4月，本研究共登记了来自全国67家中心的1440例阿替普酶静脉溶栓患者。 选取发病4.5 h内且阿替普酶使用剂量约为0.6 mg/kg（0.5～0.7 mg/kg）及0.9 mg/kg（0.85～0.95 mg/kg）的静脉溶栓患者，对溶栓后症状性颅内出血（symptomatic intracranial hemorrhage，SICH）、死亡率及90 d随访结局等进行比较。 回顾性研究 本研究提示，在中国人群中，标准剂量（0.9 mg/kg）较低剂量（0.6 mg/kg）阿替普酶静脉溶栓具有更好的有效性，且不会显著增加SICH风险。 结论 N Engl J Med 2016; ENhanced Control of Hypertension and Thrombolysis strokE stuDy (ENCHANTED) The study is being conducted in Australia and in other countries around the world. It has been designed, and is being conducted, by doctors and medical research scientists at The George Institute for Global Health, a medical research institute affiliated with the University of Sydney, in collaboration with similar people around the world. Subsequent research studies have confirmed benefits of rtPA in patients of different ages and in different populations, when used up to four and a half hours after the onset of ischaemic stroke. However, research in the last 10 years suggests that a slightly lower dose of rtPA – 0.6 mg per kilogram body weight – is equally effective and possibly even safer in terms of the risk of brain haemorrhage. As most of this research has been conducted in Japan, low-dose rtPA (0.6 mg/kg) is the standard approved treatment for acute ischaemic stroke in that country. One hypothesis is that Japanese people, and possibly other Asian people, are more sensitive to rtPA than Caucasian people