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<value>目前诊断为急性脑梗死.患者此次脑梗死(从开始出现任何症状计算)在4.5小时以内,符合中华医学会神经病学分会发布的
《中国脑血管病防治指南》中溶栓治疗适应证(年龄18~80岁;发病4.5h以内(rtPA)或6h内(尿激酶);脑功能损害的体征持
续存在超过1h,且比较严重;脑CT 已排除颅内出血,且无早期大面积脑梗死影像学改变;患者或家属签署知情同意书,
无溶栓禁忌症(
①既往史有颅内出血,包括可疑SAH;近3个月有脑梗死或心肌梗死史,但陈旧小腔隙未遗留神经功能体征者除外;
近3个月有头颅外伤史;
近3周内有胃肠或泌尿系统出血;近2周内进行过大的外科手术;近1周内有不可压迫部位的动脉穿刺;
②近3个月内有脑梗死或心肌梗死史,但不包括未遗留神经功能体征的陈旧小腔隙梗死。
③严重心、肾、肝功能不全或严重糖尿病者。
④体检发现有活动性出血或外伤(如骨折)的证据;⑤己口服抗凝药,且INR1.5;48小时内接受过肝素治疗( aPTT超出正常范围);
⑥血小板计数&lt;100,000/mm3,血糖2.7mmol/L(5Omg);⑦血压:收缩压&gt;18Ommhg,或舒张压&gt;100mmhg;
⑧妊娠⑨不合作)。为了恢复或改善缺血脑组织的灌注,防止梗死扩大,缩小脑组织缺血范围,以抢救生命,改善预后,决定行静
脉溶栓治疗,但溶栓有以下并发症:
1.出血 包括皮肤粘膜出血、肉眼及显微镜下血尿或小量咳血、呕血等(穿刺或注射部位少量淤斑不作为并发症);
大量咳血或消化道大出血、腹膜后出血等引起失血性低血压或休克;危及生命的出血:颅内、特网膜下腔、纵隔内或心包出血等。
2.一过性低血压、少数过敏反应造成发热、药疹、甚至过敏性休克、死亡。
3.溶栓失败
4.需要说明的其他情况</value>
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