动脉内溶栓治疗椎基底动脉急性脑梗死临床疗效分析

目的:分析动脉内溶栓治疗椎基底动脉(VBA)急性脑梗死的临床疗效.方法:93例VBA闭塞脑梗死患者,对43例VBA急性脑梗死患者应用尿激酶进行局部动脉内溶栓治疗,对照组50例行临床常规治疗者,比较两组疗效并分析溶栓治疗组6 h内外阻塞血管再通率和3个月后格拉斯哥预后评分(GOS)之间的关系.结果:溶栓治疗组与对照组之间有显著性差异(x2=8.76,P＜0.01),溶栓治疗组治疗时间6 h以内和6 h以外的预后比较无显著性差异(P＞0.05),溶栓后阻塞血管再通23例(53.49%);溶栓时间6 h以内6例(13.95%),其中阻塞血管再通4例(9.30%)预后均好,6 h以上37例(86.05%),阻塞血管再通19例(51.35%),预后好的有16例(43.24%);颅内出血1例(2.32%),再灌注损伤19例(44.18%);再栓塞1例(2.32%),死亡12例(27.91%),分析后认为VBA再通率较低,6 h以内和6 h以外的预后有显著性差异,血管再通和预后明显相关(P＜0.01,相关系数r=0.99).结论:VBA急性脑梗死动脉内溶栓疗效确切,阻塞血管再通和预后明显相关,阻塞血管成功再通预后较好,不成功再通预后较差,死亡率高.

Intra-arterial thrombolytic therapy in patients with acute ischemic vertebral basilar artery stroke

Objective:To analyze the efficacy of local intra-arterial thrombolysis using urokinase in patients with acute ischemic vertebral basilar artery(VBA) stroke. Methods:Ninety-three patients were angiographically examined after VBA stroke. Forty-three patients were treated with local intra-arterial thrombolysis using urokinase,others were control group. The curative effect was compared and the relationship of revascularization 6 h before and after onset with the Glasgow outcome scale(GOS) scores three months later was analyzed. Results:Angiography showed occlusion of VBA in 93 patients. There was significant difference between the therapeutic group and control group(P < 0.01). In thrombolytic group, there were no significant difference between revascularization 6 h before and after onset in clinical prognosis(P > 0.05). Successful revascularization was achieved in 23 patients. Four patients had revascularization and good prognosis with GOS three months later in 6 patients who thrombolysised within 6 h,Sixteen patients had good prognosis with GOS three months later in 19 patients who had successful revascularization among 37 patients who thrombolysised after 6 h. Twelve patients died. Hemorrhage occurred in one patient. Reperfusion injury occurred in 19 patients, and arterial reocclusion occurred in one patient. There was a significant relationship between arterial recanalization rate and clinic prognosis(P < 0.01,r = 0.99). There was low ratio of successful recanalization in VBA with poor clinic prognosis in patients who thrombolysised after 6h. Conclusion:Successful recanalization of VBA occlusive could improve intra-arterial thrombolysis,which is an effective therapy for acute ischemic VBA infarction.There was significant relationship between arterial recanalization rate and clinic prognosis.