动静脉溶栓治疗6小时内急性缺血性卒中疗效的Meta分析

目的 通过Meta分析评价动脉、静脉溶栓治疗急性缺血性卒中的疗效及安全性.方法 检索2000年1月1日-2010年8月5日,使用尿激酶或重组组织型纤溶酶原激活物,行动脉溶栓与静脉溶栓治疗急性缺血性卒中的随机对照试验的文献资料,外文文献在Medline数据库中检索,中文文献在中国万方/维普/CBMDISC/CNKI数据库...

Comparison the therapeutic effect of intra-arterial thrombolysis and intravenous thrombolysis for acute ischemic cerebral infarction within 6 hours of onset:a meta-analysis

Objective To evaluate the efficacy and safety of intra-arterial thrombolysis and intravenous thrombolysis in the treatment of acute ischemic cerebral infarction through a meta-analysis. Methods The literatures of the randomized controlled trials of using urokinase or recombinant tissue plasminogen activator for intra-arterial thrombolysis and intravenous thrombolysis in the treatment of acute ischemic cerebral infarction from January 1,2000 to August 5,2010 were reviewed. The primary outcome measures were the proportions of neurological improvement （basic cure ＋ excellent results） in the intra-arterial thrombolysis and intravenous thrombolysis groups. The secondary outcome measures were the European Stroke Scale （ESS） scores after the treatment and the proportion of symptomatic intraeranial hemorrhage. The metaanalysis software, RevMan 4.2 was applied for pooling the data of all the findings. Two reviewers extracted the data independently. Results A total of 11 articles either from foreign or domestic sources and 723 patients with acute cerebral infarction were included, in which 305 patients underwent intra-arterial thrombolysis and 418 underwent intravenous thrombolysis. （1）The total improvement rate of the intra-arterial thrombolysis was 70. 92% and that of intravenous thrombolysis was 61.29%. There was significant diffe
rence between them （X2 = 4. 895, P 〈 0.05 ）. Amelioration of neurological function deficits in the intra-arterial thrombolysis group was signifieantly higher than that in the intravenous thrombolysis group （ OR = 1. 79, 95% CI 1.19 - 2.70, P = 0. 005 ）. ESS score within 24 hours after the thrombolysis was signifieantly higher in the intra-arterial thrombolysis group than that in the intravenous thrombolysis group （ WMD = 7.69, 95% CI：4.80- 10.59 ,P 〈 0. 000 01 ）. （2）The rate of symptomatic intracranial hemorrhage in the intra-arterial thrombolysis group was 7.54% and in the intravenous thrombolysis group was 6.94%. There was no signifieant difference between the two groups （X2 = 0. 096, P 〉 0.7 ）. There was no signifieant difference in thrombolytic modes in the risk of eomplicating intracranial hemorrhage between the two groups（ OR = 1.12, 95% CI：0.63 - 2.01 ,P = 0.69）. Conclusion The effieaey of intra-arterial thrombolysis for aeute eerebral infaretion is superior to that of intravenous thrombolysis, and both the ineidenees of symptomatic intraeranial hemorrhage is comparable. A large, high-quality randomized controlled trial is need for further verification.