静脉溶栓及血管内治疗急性脑梗死的国内研究进展

急性脑梗死,又名急性缺血性脑卒中,是指由缺血缺氧引起的脑组织坏死软化引起的神经功能缺损综合征。作为一种严重的具有高致残率、高死亡率,并发症高发生率的神经系统疾病,急性脑梗死为患者家庭及社会带来沉重负担。急性缺血性脑卒中超急性期治疗的关键在于尽早开通闭塞血管、恢复血流以挽救缺血半暗带。目前,针对急性缺血性脑卒中的超急性期治疗措施主要包括静脉溶栓和血管内介入治疗。发病时间窗内采用静脉溶栓是治疗超急性期急性缺血性卒中的首选方法,获得了国内外指南的一致推荐。溶栓药物主要是纤维蛋白溶解酶原激活剂,该类药物能直接或间接激活纤维蛋白溶解酶原成纤维蛋白溶解酶,并降解纤维蛋白,从而达到溶栓的目的。然而对于大血管闭塞性脑梗死,静脉溶栓血管再通率偏低,血管内治疗可以直观地观察血栓溶解及血管再通情况,提高血管再通率,改善临床预后,比如动脉溶栓、机械取栓等。近些年,国内研究人员对此做了很多探索,静脉溶栓、血管内治疗的临床研究呈现逐渐增多的态势。本文旨在寻找更佳的临床证据,提升临床医疗实践质量。同时,也发现国内研究仍然存在诸多问题,限制了研究成果的参考价值,比如研究方法学存在较大差异、新型溶栓药物临床研究少、机械取栓技术缺乏统一规范等,期待进一步的改善。 

Domestic research progress of intravenous thrombolysis and intravascular treatment of acute cerebral infarction

Acute cerebral infarction, also known as acute ischemic stroke, refers to the neurologic deficit syndrome caused by the ischemia and anoxic state in brain tissue. As a serious nervous system disease with high disability rate, high mortality rate and high incidence of complications, acute cerebral infarction brings heavy burden to our family and society. The key point of treatment is to open the occluded vessels and restore the blood flow as early as possible to save the ischemic penumbra. At present, the most effective treatments for hyperacute cerebral infarction mainly includes intravenous thrombolysis and intravascular intervention. Intravenous thrombolysis is the first choice and recommended by domestic and international guidelines. Most of the thrombolytic drugs are fibrinolytic enzyme activators, which can directly or indirectly activate fibrinolytic enzyme and degrade fibrin, so as to achieve the goal of thrombolysis. However, the recanalization rate of intravenous thrombolysis is low in patients with large vessel occlusive cerebral infarction. Intravascular therapy can directly observe thrombolysis and recanalization, improve recanalization rate and improve clinical prognosis, such as arterial thrombolysis, mechanical thrombectomy and so on. In recent years, domestic researchers have done a lot of exploration. The clinical research of intravenous thrombolysis and intravascular therapy is increasing gradually. This article makes a brief review of this, in order to find better clinical evidence and improve the quality of clinical medical practice. At the same time, it is found that there are still many problems, which limits the reference value of the results, such as the large differences in research methodology, the lack of clinical research on new thrombolytic drugs, the lack of unified specifications of mechanical thrombectomy technology, etc. We are looking forward to the further improvement.