动脉溶栓和动静脉联合溶栓及机械取栓治疗急性脑梗死的比较研究

目的评价动脉溶栓、动静脉联合溶栓和单纯机械取栓治疗急性脑梗死的疗效及安全性。方法选择急性脑梗死颅内血管狭窄或闭塞患者61例,根据不同溶栓方法分动脉溶栓组25例,动静脉联合溶栓组(联合溶栓组)17例,单纯机械取栓组(机械取栓组)19例。分别对治疗前后患者的美国国立卫生研究院卒中量表(NIHSS)评分、治疗的有效性、近期与远期疗效进行分析。结果与治疗前比较,动脉溶栓组、联合溶栓组治疗后2周NIHSS评分明显降低(P<0.05,P<0.01),机械取栓组治疗后3d、2周NIHSS评分明显降低(P<0.05,P<0.01)。动脉溶栓组残余狭窄率≤30%发生率、急性血管再闭塞率和病死率分别为16.0%、52.0%和12.0%,联合溶栓组分别为11.8%、52.9%和0,机械取栓组分别为47.4%、0和10.5%。3组残余狭窄率≤30%发生率、急性血管再闭塞率比较,差异有统计学意义(P<0.05,P<0.01)。结论不论采用动脉溶栓、动静脉联合溶栓还是机械取栓方法,均可使患者神经功能改善,对近期临床预后的改善有相近效果。采用机械取栓方法对神经功能改善时间较早、溶栓效果、安全性及远期临床预后较好。

Intraarterial thrombolysis,combined intravenous and intraarterial thrombolysis,mechanical thrombectomy in treatment of ACI

Objective To assess the effect and safety of intraarterial thrombolysis,combined intravenous and intraarterial thrombolysis,and mechanical thrombectomy in treatment of acute cerebral infarction(ACI).Methods Sixty-one patients with intracranial large blood vessel stenosis or occlusion due to ACI were divided into intraarterial thrombolysis group(n=25),combined intravenous and intraarterial thrombolysis group(n=17),and mechanical thrombectomy group(n=19).The NIHSS score before and after treatment,therapeutic efficiency,short-and long-term curative effect were analyzed.Results The NIHSS score was significantly lower in intraarterial thrombolysis group and combined intravenous and intraarterial thrombolysis group 2 weeks after treatment than before treatment,and in mechanical thrombectomy group 3 days and 2 weeks after treatment than before treatment(P<0.05,P<0.01).The incidence of residual stenosis,acute reclusion,and death was 16.0%,52.0%,12.0% respectively in intraarterial thrombolysis group,11.8%,52.9%,0% respectively in combined intravenous and intraarterial thrombolysis group,47.4%,0%,10.5% respectively in mechanical thrombectomy group(P<0.05,P<0.01).The incidence of residual stenosis was ≤30% in 3 groups(P<0.05,P<0.01).Conclusion Intraarterial thrombolysis,combined intravenous and intraarterial thrombolysis,and mechanical thrombectomy can improve the nerve function in patients with ACI.Mechanical thrombectomy can achieve the better efficacy,safety and outcome than combined intravenous and intraarterial thrombolysis in patients with acute ischemic cerebral strok.