根據(jù)一項(xiàng)最新研究發(fā)現(xiàn)：使用超聲波合并應(yīng)用組織-纖維蛋白溶酶原激活劑(tissue-plasminogen activator, t-PA)，能夠改善缺血性腦卒中的預(yù)后。該研究比較了聯(lián)合應(yīng)用超聲波和t-PA與單獨(dú)使用t-PA的作用與安全性，研究涉及了126例患者。

研究人員評(píng)估了使用穿透頭顱的多普勒超聲波(transcranial Doppler ultrasound, TCD)合并使用t-PA的治療效果。較早期的研究已經(jīng)證實(shí)在缺血性腦卒中發(fā)作后3小時(shí)內(nèi)應(yīng)用t-PA，能夠極大地增加患者完全恢復(fù)的幾率。但是這個(gè)藥物不能用于出血性腦卒中的治療。

一個(gè)國際研究小組研究了126例缺血性腦卒中患者；所有患者在卒中發(fā)作后3小時(shí)內(nèi)應(yīng)用了t-PA。其中對(duì)照組63例患者僅僅使用t-PA；而其它63例患者使用t-PA，并且在患者使用t-PA之前開始持續(xù)使用TCD監(jiān)測(cè)。將一個(gè)小設(shè)備貼附在患者頭顱上用來發(fā)送超聲波。研究結(jié)果發(fā)表于2004年11月18日第2204期的《新英格蘭醫(yī)學(xué)期刊》(the New England Journal of Medicine)。

結(jié)果證實(shí)：在持續(xù)接受超聲波和t-PA的患者中，有49％在治療后的2小時(shí)內(nèi)，臨床情況發(fā)生明顯改善，很少或者沒有血流阻斷；而單獨(dú)使用t-PA的只有30％。值得指出的使，在接受持續(xù)TCD和t-PA的患者中，有38％患者被證實(shí)2小時(shí)內(nèi)沒有發(fā)生血流阻斷，而單獨(dú)使用t-PA的只有13％。所有73％接受聯(lián)合治療的患者出現(xiàn)完全或者部分的血栓清除，而對(duì)照組只有50％。兩個(gè)治療組都有4.8％患者發(fā)生腦組織出血。腦組織早期血流改善產(chǎn)生了這樣的趨勢(shì)：超過13.5％的接受持續(xù)TCD和t-PA治療的患者在腦卒中發(fā)作后3月內(nèi)完全恢復(fù)。

這些科學(xué)家還發(fā)現(xiàn)：在治療后2小時(shí)內(nèi)完全清除血凝塊的患者，其語言、機(jī)體力量、以及其它受到腦卒中影響的功能獲得恢復(fù)的幾率最大。研究人員將該研究稱為 "聯(lián)合穿越頭顱超聲波以及系統(tǒng)使用t-PA治療所產(chǎn)生的缺血性腦卒中的血栓裂解"(Combined Lysis of Thrombus in Brian Ischemia Using Transcranial Ultrasound and Systemic t-PA, CLOTBUST)

“在過去30年中，世界范圍內(nèi)的科學(xué)家已經(jīng)證實(shí)超聲波是一項(xiàng)快速、溫和以及有效的裂解血凝塊的方法。我們是首次在患者中證實(shí)了其療效。這種方法增加了流向腦組織的血流，改善了臨床預(yù)后，并且有利于患者的護(hù)理者，”該項(xiàng)研究的負(fù)責(zé)人Andrei Alexdrov醫(yī)學(xué)博士說。他是德克薩斯-休斯頓大學(xué)醫(yī)學(xué)院神經(jīng)病學(xué)副教授。

美國國立神經(jīng)系統(tǒng)疾病與腦卒中研究院(NINDS; Bethesda, MD., USA)主任Story C. Landis博士評(píng)論說：“腦卒中對(duì)患者以及他們的護(hù)理者而言都是后果嚴(yán)重的。這些初步結(jié)果提示：在缺血性腦卒中發(fā)作之后患者接受聯(lián)合治療能夠給醫(yī)院更多機(jī)會(huì)。這是一項(xiàng)鼓舞人心的進(jìn)步，將改進(jìn)目前的治療方法并促使疾病向好的方向發(fā)展。”該研究獲得了NINDS的部分資助。

超聲波能夠使血栓組織內(nèi)的分子產(chǎn)生振動(dòng)，從而可以為t-PA創(chuàng)造更多的結(jié)合位點(diǎn)，促使血凝塊崩解。研究人員相信：與單獨(dú)應(yīng)用t-PA相比較，這種分子振動(dòng)促使藥物運(yùn)輸至血凝塊內(nèi)以及周圍，從幫助開放更多的阻斷血管。

Ultrasound Plus t-PA Improves Stroke Outcome
 
Utilizing ultrasound combined with the drug tissue-plasminogen activator (t-PA) can improve the outcome of an ischemic stroke, according to a new study. The study compared the efficacy and safety of ultrasound with t-PA vs t-PA only in a trial involving 126 patients.

The investigators evaluated the effectiveness of using transcranial Doppler ultrasound (TCD) in combination with t-PA. Earlier studies have demonstrated that t-PA, when administered within three hours of onset of ischemic stroke, can greatly improve a patient’s likelihood of a full recovery. This agent, however, cannot be used to treat a typical hemorrhagic stroke.

An international group of investigators examined 126 patients who suffered an ischemic stroke; all patients received t-PA within three hours after stroke onset. The 63 patients in the control group received t-PA alone, while the other 63 patients received the agent in combination with continuous TCD monitoring that began right before the patients received t-PA. A small device attached to a head frame was used to deliver the ultrasound waves. The study was published in the November 18, 2204, issue of the New England Journal of Medicine.

Results demonstrated that 49% of patients who received continuous ultrasound and t-PA showed drastic clinical improvement and little or no blockage within two hours after therapy began compared to 30% of patients who received t-PA alone.

Remarkably, 38% of the patients who received continuous TCD and t-PA demonstrated no blockage within two hours, compared to 13% who received t-PA alone. All 73% of patients who received the combined therapy demonstrated total or partial clearance of the thrombus, compared to 50% in the control group. Bleeding into the brain was seen in 4.8% of patients in both groups. This early improvement of blood flow to the brain resulted in a trend by which 13.5% more patients who received continuous TCD and t-PA had recovered completely by three months after stroke.

The group of scientists also discovered that patients who had complete clearance of their clot within two hours following treatment had the greatest probability of regaining speech, body strength, and other functions affected by stroke. The nvestigators called the trial CLOTBUST (Combined Lysis of Thrombus in Brian Ischemia Using Transcranial Ultrasound and Systemic t-PA).

“In the past 30 years, scientists around the world have shown that ultrasound is fast, gentle, and effective in helping t-PA to break up clots. For the first time, we have demonstrated this benefit in patients. This approach enhances flow to the brain and augments clinical recovery and their caregivers,