动静脉联合溶栓治疗急性缺血性脑卒中的Meta分析

目的对动静脉联合溶栓治疗急性缺血性卒中的疗效及安全性进行Meta分析。方法根据预定的纳入、排除标准,在Medline及万方数据率、CNKI数据库中进行相关检索,由2名评价员独立提取资料。应用RevMan5.1软件包对各研究结果进行数据合并分析。结果纳入1999—2011年国内外文献7篇,共352例患者,其中177例动静脉联合溶栓,175例单一静脉/动脉溶栓或基础治疗。(1)动静脉联合溶栓组神经功能缺损的总改善率为67.23%,对照组为44.00%,差异有统计学意义(χ~2=4.15,P<0.05),联合组的神经功能改善情况优于对照组(OR=2.67,95%CI 1.68～4.26,P=0.01)。(2)联合组溶栓后24 h ESS评分明显高于对照组(加权平均差=15.65,95%CI 9.30～21.99,P<0.01)。(3)动静脉联合溶栓组合并症状性颅内出血率为9.04%,对照组为9.73%,2组比较差异无统计学意义(χ~2=0.17,P>0.05)。结论急性缺血性卒中患者动静脉联合溶栓疗效优于单一静脉/动脉溶栓或基础治疗,而继发症状性颅内出血率相当。

Meta analysis:The effect of combined intra-venous and intra-arterial thrombolysis in the treatment of acute ischemic cerebral infarction

Objective To evaluate the efficacy and safety of combined intra-venous and intra-arterial thrombolysis in the treatment of acute ischemic cerebral infarction through a Meta-analysis.Methods According to predetermined criteria of inclusion and exclusion,we collected the corresponding randomized controlled trials in databases of Medline,Wanfang data and CNKI.The Meta-analysis software,RevMan 5.1 was applied for pooling the data of all the findings.Two reviewers analyzed these data independently.Results A total of 7 articles either from foreign or domestic sources and 352 patients with acute cerebral infarction were included from 1999 to 2011,in which 177 patients underwent combined intravenous and intra-arterial thrombolysis and 175 patients underwent intra-venous thrombolysis or intra-arterial thrombolysis or basic treatments.(1)The total improvement rate of the combined group was 67.23%and that of the control group was 44.00%.There was significant difference between them(χ~2=4.15,P<0.05),the neural function improvement in combined gorup was better than control group(OR=2.67,95%CI 1.68～4.26,P=0.01).(2)ESS score within 24 hours after the thrombolytic was significantly higher in the combined group than that in the control group(WMD=15.65,95%CI 9.30～21.99,P<0.01).(3)The rate of symptomatic intracranial hemorrhage in the combined group was 9.04%and in the control group was 9.73%.There was no significant difference between the two groups(χ~2=0.17,P>0.05).Conclusion The efficacy of combined intravenous and intra-arterial thrombolysis for acute cerebral infarction is superior to that of intra-venous thrombolysis or intra-arterial thrombolysis or basic treatments,nevertheless the incidences of secondary intracranial hemorrhage are similar in the two groups.