Thrombolytic drugs such as plasminogen activator are used to directly or indirectly dissolve fibrin in thrombus, thus reopening blocked blood vessels. This treatment is called thrombolytic therapy. Thrombolysis is mainly suitable for the treatment of acute myocardial infarction, acute cerebral infarction and pulmonary embolism. Intravenous thrombolysis is the most commonly used thrombolytic therapy. The thrombolytic scheme should be decided according to the patient's condition. The commonly used methods are as follows: 1. Intravenous injection of urokinase 300-500,000 u+ 20ml of normal saline for continuous use 1 10,000 U+ normal saline 100 ml intravenous drip; After thrombolysis for 6~ 12 hours, heparin or low molecular weight heparin was given anticoagulant therapy. The side effect of thrombolysis is mainly bleeding. Patients who may cause bleeding after using this drug, especially those who are at risk of visceral or cerebral hemorrhage, should not be treated with thrombolysis.
Simple and understandable explanation method of thrombolysis
There is ice blocking the water pipe, which makes the water unable to flow. Therefore, in order to keep the water flowing, it is necessary to melt the "ice" blocking the water pipe with hot water, so that the water can be unblocked!
What are the absolute and relative contraindications of thrombolysis?
Intravenous thrombolysis is the most important measure to restore cerebral blood perfusion at present, and thrombolysis is the first recommended method to treat patients with acute ischemic stroke in the treatment guidelines all over the world.
First, the absolute contraindication of intravenous thrombolysis
●CT shows intracranial hemorrhage or defines the focus of acute cerebral infarction;
Intracranial lesions with high possibility of bleeding (such as brain tumor, abscess, vascular malformation, aneurysm, brain contusion);
Definite bacterial endocarditis.
B, intravenous thrombolysis relative contraindications
● Age is less than 18 years old or over 80 years old;
● Slight or rapid improvement of neurological deficit;
● Have a clear history of external injuries within 3 months;
● Cardiopulmonary resuscitation; Chest compressions were performed within 10 days;
● Have a history of stroke within 3 months;
● Past intracranial hemorrhage, including suspected subarachnoid hemorrhage;
● Major surgery in the past 2 weeks;
● Minor surgery was performed in recent 10 days, including liver and kidney biopsy, chest puncture and lumbar puncture;
●/kloc-arterial puncture of incompressible parts within 0/4 days;
● Pregnant (postpartum 10 day) or lactating women;
● History of gastrointestinal bleeding, urethral bleeding and respiratory bleeding within 3 weeks;
Clear the nature of bleeding (including renal function and liver dysfunction);
● The expected life caused by other reasons is less than 1 year;
Peritoneal dialysis or hemodialysis;
●PTT & gt； 40 seconds, platelet count
● presence or absence of anticoagulants, INR> 1.7 (if there is no INR, PT> 15);
Low systolic blood pressure > 180 or diastolic blood pressure >; 1 10, and the management has taken measures to reduce the pressure;
● Seizure after stroke;
● Blood sugar is lower than 2.8mmol/L or higher than 22.2 mmol/L;
● Conditions that may increase the risk of bleeding (NIHSS >；); 20, age > 75. Early CT showed edema with occupying effect.
What is early thrombolysis?
The so-called thrombolytic therapy is to use drugs to dissolve thrombus and achieve the purpose of recanalization of blood vessels, so that the brain tissue in the blocked vascular perfusion area can get oxygen supply again. Because fibrin is an important component of thrombus, fibrinolytic drugs are mainly used in thrombolytic therapy at present. These drugs include streptokinase, urokinase and tissue plasminogen activator. Specific methods: (1) streptokinase: it can transform fibrinogen into active fibrinolytic enzyme, thus dissolving thrombus. Normal saline or 5% glucose (100 ml) was added to the routine dosage of 500,000 units, and the drip was completed within 30 minutes, and the maintenance amount was 5 ~ 654.38+10,000 units per hour until the thrombus dissolved or the disease no longer developed. It usually takes 12 hour to 5 days. However, because streptokinase has antigenicity and pyrogen, it often has obvious side effects after use, so it is generally not used. (2) Urokinase: It can activate fibrinogen and dissolve thrombus. The usual dosage is 1 ~ 20000 units, plus 5% glucose 500 ml intravenous drip. 65438+ 0 ~ 2 times a day for 5 ~ 7 days. (3) Tissue plasminogen activator: It is specific for blood clots, can selectively act on local thrombus, does not cause systemic fibrinolysis, is safe to use and has no allergic reaction, but it has not been widely used in clinic due to the lack of drug sources. In recent years, thrombolytic therapy has been used to treat ischemic stroke, which has made many patients recover their severely paralyzed limbs quickly and achieved gratifying results. However, thrombolytic therapy has the risk of bleeding at the infarct site. If the indications and contraindications are not well mastered, the condition can be aggravated and even life-threatening. Therefore, this therapy should be carried out under the guidance of experienced doctors in qualified hospitals. The principle of thrombolytic therapy: CT examination must be done before treatment to rule out cerebral hemorrhage. Cerebrospinal fluid examination should be colorless and transparent, with red blood cells below 0.3× 109/L, blood pressure below180/10mmhg, and platelet count, clotting time, prothrombin time and activity within normal range. At the same time, we should also choose the best treatment opportunity. Generally speaking, it should be carried out within 6 hours of onset. If it exceeds 12 hours, the curative effect is poor and it is easy to cause serious side effects such as cerebral hemorrhage. Why should thrombolysis be used in the early stage of ischemic stroke? This is because the brain tissue has poor tolerance to ischemia. If cerebral ischemia lasts for several hours, it will inevitably lead to ischemic necrosis of brain tissue. The range of ischemic necrosis is mostly fixed within 6 ~ 12 hours, but once the range of ischemic necrosis of brain tissue is fixed, thrombolytic therapy can restore the blood supply of occluded blood vessels, but it can not narrow the range of brain tissue necrosis, on the contrary, hemorrhagic cerebral infarction can occur. Therefore, for ischemic stroke, time is life, and it should be sent to the hospital as soon as possible after the onset.
What is the best thrombolytic drug in China?
The best rescue time is within 3 hours.
zhidao.baidu/question/307 14839? si = 10
Brief introduction of thrombolytic drugs
The first generation of thrombolytic drugs in the early days included streptokinase (SK), urokinase (UK), lumbrokinase (pro-urokinase), glucokinase, methoxybenzoyl plasminogen streptokinase activator and snake venom antithrombotic enzyme.
The second-generation thrombolytic drug, Atypinase (t-PA), is a recombinant tissue plasminogen activator and the first recombinant thrombolytic drug in the world, which was developed and marketed by Genetech Company of the United States. Because drugs need to be expressed in eukaryotic cells, the process requirements are high and the clinical dosage is large, so there are some problems in their production.
At present, thrombolytic drugs have developed to the third generation. Retavase (trade name Retavase) developed by Boehringer Mannheim Co., Ltd. in 1996 is one of the representatives. Reteplase, a protein-modified drug, is a deletion variant of recombinant human tissue plasminogen activator, which has the advantages of long half-life, strong thrombolytic effect and less side effects, and has attracted the attention of cardiovascular and cerebrovascular experts.
The third generation thrombolytic drugs being developed are all t-PA variants, such as TNKase(teneplase, TNK-t-PA), Monteplase, La noteplase(nateplase, n-PA) and so on. The third generation thrombolytic drugs are characterized by rapid thrombolysis, opening blocked coronary artery and restoring blood circulation, and the cure rate is 73% ~ 83%. But also has the advantages of long half-life without intravenous injection and dose adjustment due to weight in hospitals.
2 development process and recent situation
2. 1 foreign related research
German Boehringer Mannheim Company invested 654.38+0 billion US dollars, and began to develop the third generation t-PA in the late 1980s. Reteplase 1996 came out. Kalyan et al. obtained a variant with deletion of N-terminal structural region of T-PA, and reported its structural function and biochemical characteristics. Kohnert et al. analyzed the primary structure, biochemical characteristics and kinetics of reteplase. It is proved that the drug has similar biological activity and fibrin affinity to CHO expression products. Two domains of CHO-expressed t-PA variant, kringle2 and protease domain, were also reported. In vitro experiments show that the fibrinolysis rate is significantly different from that of t-PA. In recent years, foreign research mainly focuses on the clinical efficacy of these drugs.
2.2 China related research
In 2002, National Medical Products Administration approved the second phase clinical trial of reteplase for injection produced by Shandong Longyuan Biotechnology Co., Ltd. and Jiangsu Suzhong Pharmaceutical Factory. Suzhou Zhong Kai Biopharmaceutical Co., Ltd. plans to invest 69.562 million yuan to build a project with an annual output of 80,000 sets of reteplase injection.
3 Conclusion
The third generation thrombolytic drugs are very competitive in clinic because of their long half-life and small side effects. The cost of prolonging the life of each patient is $65,438+￡ 04,438 when treating AMI with ritavasa from Boehringer Mannheim/Cantoco Company.
Therefore, the research and development of low-cost thrombolytic drugs has significant economic benefits and great social significance. Domestic biotechnology enterprises should reduce their prices to a level that ordinary people can afford. At the same time, it is suggested that scientific research units and production enterprises pay more attention to other third-generation thrombolytic drugs in order to obtain thrombolytic drugs with independent intellectual property rights and develop engineering bacteria drugs for the research and development of third-generation thrombolytic drugs in China. ......
Is there any good medicine for cerebral infarction?
Cerebral infarction is a cerebrovascular disease, which is caused by cerebral atherosclerosis and vascular intima injury, and then local thrombosis is formed due to various factors, which aggravates or completely occludes arterial stenosis, leading to ischemia, hypoxia, brain tissue necrosis and neurological dysfunction.
The main factors of cerebral infarction are hypertension, coronary heart disease, diabetes, overweight, hyperlipidemia and eating fat. Many patients have family history. It is more common in middle-aged and elderly people aged 45 ~ 70.
(A) Precursor symptoms of cerebral infarction
Most patients with cerebral infarction get sick during quiet rest. Some patients wake up to find their mouth and eyes askew, hemiplegia, drooling, eating rice grains and unable to lift chopsticks. This is the occurrence of cerebral infarction, which often makes people unprepared. Only some patients have symptoms of transient cerebral ischemia such as numbness of limbs, slurred speech, transient blackness, dizziness or vertigo, nausea, blood pressure fluctuation (which can be increased or decreased) before onset. These premonitory symptoms are generally mild and short-lasting, and are often ignored.
(2) Clinical manifestations of cerebral infarction:
The location and area of infarction are different, and the most common manifestations are as follows:
(1) Sudden onset, often occurring during quiet rest or sleep. The peak of onset is within several hours or 1 ~ 2 days.
(2) Headache, dizziness, tinnitus, hemiplegia, which can be one limb or one limb, and the upper limb is heavier than the lower limb or the lower limb is heavier than the upper limb, with dysphagia, slurred speech, nausea and vomiting. In severe cases, you will soon be unconscious. Every patient can have the above-mentioned clinical manifestations.
(3) Significance of brain CT examination: The accuracy of brain CT examination in showing the size and location of cerebral infarction focus is 66.5% ~ 89.2%, and the accuracy of first cerebral hemorrhage is 65,438+0,000%. Therefore, early CT examination is helpful for differential diagnosis and elimination of diseases such as cerebral hemorrhage. This is very important. The treatment of cerebral hemorrhage and cerebral thrombosis in the early stage of onset is very different. When the onset of cerebral infarction is within 24 hours, or the infarction focus is less than 8 mm, or the lesions are in the brain stem and cerebellum, brain CT examination often cannot provide a correct diagnosis. If necessary, it should be reexamined in a short time to avoid delaying treatment.
(4) There is a disease called "lacunar cerebral infarction", in which patients may have no symptoms or mild symptoms. CT examination of other diseases has found this disease, and some of them are old lesions. This situation is more common in the elderly, and patients are often accompanied by chronic diseases such as hypertension, arteriosclerosis, hyperlipidemia, coronary heart disease and diabetes. Lacunar cerebral infarction can recur, some patients eventually develop into symptomatic cerebral infarction, and some patients have been stable for many years. Therefore, we should pay attention to the "asymptomatic stroke" of the elderly and take a positive preventive attitude.
(3) Rescue measures for cerebral infarction:
Cerebral infarction should be treated as soon as possible. Although it is not as dangerous as cerebral hemorrhage, most patients are old and weak, with many chronic diseases, and there are many cases of careful medication in treatment. In addition, the infarct area can be enlarged in a short time, and there will be many complications, so the mortality rate of cerebral infarction is relatively high, and the disability rate is higher than that of cerebral hemorrhage.
The treatment principle is mainly to improve cerebral circulation, prevent and treat brain edema and treat complications.
1? Proper exercise can improve cerebral circulation, but coma patients should stay in bed and strengthen nursing.
2? Improve cerebral blood circulation, increase cerebral blood flow, promote the establishment of collateral circulation, and reduce the infarct area. Low molecular dextran, 706 generation plasma, Venoruton, compound Danshen injection, ligustrazine, etc. All of them were given intravenous drip of 250-500ml for 7- 10 day. Headache, nausea, vomiting or disturbance of consciousness can be dehydrated with 20% mannitol, 250 ml, twice a day.
3? Thrombolytic therapy commonly uses urokinase and streptokinase to dissolve thrombus. 20000 ~ 50000 units of urokinase made in China were added into 0.56 mol/L 10% glucose solution for intravenous drip, once a day, and each course of treatment was 1 0 day. Some people also use urokinase to treat cerebral infarction through carotid artery, which is usually applied within 24 hours of onset. Because it is difficult to inject drugs through carotid puncture, it must be used in hospitals. Thrombolytic therapy should be applied early because thrombosis 1 day is rich in water, easy to dissolve, quick to take effect and short in course of treatment, but the condition should be closely observed to avoid the serious consequences of cerebral hemorrhage.
4? Hyperbaric oxygen therapy has been proved to be very effective in treating cerebral infarction, which can greatly reduce the disability rate of cerebral infarction. Suitable for early application, once a day, 10 times is 1 course of treatment, and the oxygen inhalation time is 90 ~1/0 minutes each time. ......
What does thrombolysis plus pci mean?
Hello, for acute cardiovascular and cerebrovascular accidents, pci has obvious effect after thrombolysis failure. I suggest you transfer to another hospital for treatment according to the doctor's advice.
What does rtPA mean? Five points.
Recombinant tissue plasminogen activator
It can activate plasminogen, thus dissolving thrombus. It is a commonly used drug in the field of thrombolysis. At present, it is mostly used to treat catheter-related thrombosis.
What does feeling thrombolysis mean?
Mesenteric artery thrombolysis, A stands for artery.