动脉和静脉溶栓治疗大脑中动脉闭塞的回顾性分析

目的初步评价动静脉溶栓治疗大脑中动脉闭塞的效果。方法回顾性分析经动静脉溶栓治疗的大脑中动脉闭塞59例患者（动脉溶栓27例，静脉溶栓32例）的临床资料。采用Mori分级评价血管再通程度，GOS评价患者预后。结果动脉溶栓组血管再通程度达MoilIV级14例，Ⅱ～Ⅲ级6例，0～I级者5例，2例出现脑出血。静脉溶栓组血管再通程度达MoriIV级者6例，Ⅱ-Ⅲ级者9例，0-I级者16例，1例出现脑出血。溶栓治疗90d后按GOS评价预后，动脉溶栓组恢复良好者12例（44．4％，12／27），中度残障、重度残障及死亡者15例；静脉溶栓组恢复良好者6例（18．7％，6／32）中度残障、重度残障及死亡者26例。两组之间血管再通（包括MoriⅡ～IV级）率动脉溶栓组和静脉溶栓组分别为74．2％（20／27）和46．9％（15／32）1及恢复良好率均差异显著（P〈0．05）。结论动脉溶栓较静脉溶栓更有利于完全闭塞的大脑中动脉的再通和改善患者预后。

Analysis of curative effects of intraarterial and intravenous thrombolysis on middle cerebral artery occlusion

Objective To analysis the curative effect of intraarterial and intravenous thrombolysis on middle cerebral artery （MCA） occlusion. Methods The clinical data of 59 patients with MCA occlusion, of whom, 27 were treated by the intraarterial thrombolysis and 32 by the intravenous thrombolysis, were analyzed retrospectively. The degree of recanalization of the occluded MCA was assessed by Mori grading system, and the prognoses of the patients were evaluated by GOS. Results Of 27 patients treated by the intraarterial thrombolysis, 14 had Mori grade IV MCA recanalization, 6 Mori grades Ⅱ-Ⅲ, 5 Mori grades 0~ J and 2 had cerebral hemorrhage. Of 32 patients treated by the intravenous thrombolysis, 6 had Mori grade IV MCA recanalization, 9 Mori grades Ⅱ-Ⅲ, 16 Mori grades 0~ Ⅰ and 1 had cerebral hemorrhage. Of 27 patients treated by the intraarterial thrombolysis, 12 （44.4%, 12/27） were recovered well and 15 had poor prognoses （including middle and serve disability and death）. Of 32 patients treated by the intravenous thrombolysis, 6 （18.7%, 6/32） were recovered well and 26 had poor prognoses （including middle and serve disability and death）. There were significantly differences in the effective rate of MCA recanalization （including Mori grades Ⅱ-Ⅳ） and the rate of good prognosis between both the groups （P〈0.05）. Conclusion The intraarterial thrombolysis is more helpful to the occluded MCA recanalization and improvement of the prognoses in the patient with MCA occlusion compared to the intravenous thrombolysis.