目的：探讨尿激酶静脉溶栓与超选择性动脉溶栓治疗脑梗死的临床效果。方法将64例脑梗死患者按随机数字表法分为2组，每组32例。动脉溶栓组采用超选择性尿激酶动脉溶栓治疗；静脉溶栓组采用尿激酶静脉溶栓治疗。对2组治疗前后神经功能缺损[美国国立卫生院脑卒中神经缺损评分量表（NIHSS）]、日常生活能力[改良巴氏指数（BI 指数）]、近期总体治疗效果、不良事件（症状性颅内出血、非症状性颅内出血、其他系统出血发生与死亡人数）发生率与病死率及远期预后效果等进行比较。结果2组治疗前 NIHSS 评分及 BI 指数比较差异无统计学意义（P ＞0．05）；2组治疗后 NIHSS 评分明显低于治疗前、BI 指数明显高于治疗前，动脉溶栓组 NIHSS 评分较静脉溶栓组降低更明显，BI 指数较静脉溶栓组升高更明显（均 P ＜0．01）。动脉溶栓组显效率、总有效率及预后良好率均明显高于静脉溶栓组、总体出血率明显低于静脉溶栓组（均 P ＜0．05）。2组患者症状性颅内出血、非症状性颅内出血、其他系统出血发生率及病死率比较差异均无统计学意义（均 P ＞0．05）。结论超选择性动脉溶栓治疗脑梗死患者的近期疗效更好，安全性更高；且远期预后较好，具有借鉴性。%Objective To investigate the clinical efficacies of intravenous and super-selective in-traarterial thrombolysis with urokinase in the treatment of cerebral infarction.Methods Sixty-four patients with cerebral infarction were randomly assigned to receive either super-selective in-traarterial urokinase thrombolysis(intraarterial thrombolysis group,n=32)or intravenous uroki-nase thrombolysis(intravenous thrombolysis group,n=32).Neurological deficits and activities of daily living were evaluated by using the National Institutes of Health Stroke Scale(NIHSS)and the modified Barthel index(BI),respectively.In addition,short-term efficacy,incidence of adverse events(symptomatic intracranial hemorrhage,asymptomatic intracranial hemorrhage and seconda-ry hemorrhage),mortality,and long-term prognosis were compared between the two groups.Re-sults There were no significant differences in NIHSS score and BI between the two groups be-fore treatment (P > 0.05 ).After treatment,NIHSS score decreased and BI increased in both groups(P <0.01).Furthermore,the decrease in NIHSS score and the increase in BI in intraarteri-al thrombolysis group were more obvious than those in intravenous thrombolysis group (P <0.01).Moreover,compared with intravenous urokinase thrombolysis,super-selective intraarterial urokinase thrombolysis increased the marked improvement rate,overall response rate and good prognosis rate,and decreased the overall bleeding rate(P <0.05).No significant differences in the incidence of symptomatic intracranial hemorrhage,asymptomatic intracranial hemorrhage and sec-ondary hemorrhage and the mortality were found between the two groups(P >0.05).Conclusion Super-selective intraarterial urokinase thrombolysis provides better short-term efficacy and long-term prognosis and higher safety than intravenous urokinase thrombolysis for treating cerebral in-farction.
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