前、后循环超急性期脑梗死动脉溶栓治疗的临床分析

目的：评价完全前循环（颈内动脉系统）梗塞（TACI）与后循环（椎一基底动脉系统）梗塞（POCI）在超急性期脑梗死经股动脉选择性溶栓（IAT）疗效的影响因素及安全性.方法：选择超急性期脑梗死患者共62例,其中发病6 h内的TACI患者44例,起病12 h内的POCI患者18例,行股动脉穿刺,经微导管对梗死部位接触性给予尿激酶或重组组织型纤溶酶原激活剂（rtPA）作动脉溶栓治疗,进行两组患者治疗前、治疗后2 h、24 h、7 d、90 d的神经功能缺损程度评分（NIHSS）以及治疗前、治疗后21 d、90 d的Barthel指数（BI）比较,记录两组的不良事件.并分析脑梗死的性质、部位及给药时间对血管再通率及预后的影响.结果：（1）两组患者在溶栓后2 h、24 h.7 d及90 d的NIHSS评分与溶栓后21 d及90 dBI评分均较治疗前有明显改善.两组患者治疗后不同时间点的NIHSS评分与BI评分有统计学差异（均P＜0.05）.（2）TACI患者给药时间＜4.5h组和4.5～6 h组患者溶栓治疗后血管再通率比治疗前明显改善（均P＜0.05）,且＜4.5 h组血管再通率高于4.5～6 h组（P＜0.05）.POCI患者给药时间＜9h组和9～12 h组患者溶栓治疗后血管再通率比治疗前明显改善（均P＜0.05）,且＜9 h组血管再通率高于9～12 h组（P＜0.05）.（3）脑血栓形成亚组与脑栓塞亚组治疗后的血管再通率均较治疗前改善（P＜0.05）,且脑血栓形成亚组的血管再通率高于脑栓塞亚组（P＜0.05）.结论：动脉溶栓治疗前后循环超急性期脑梗死均有效,对TACI疗效优于POCI 各责任血管再通率不同 但POCI更应积极动脉溶栓 给药时间越早疗效越好,安全性越高.心源性脑栓塞的疗效比脑血栓形成的疗效差.

Clinical analysis of the intra-artery thrombolytic therapy of acute anterior circulation and posterior circulation infaction

Objective ：To study the efficacy,safety and the influencing fator of the intra-artery thrombolytic therapy of acute total anterior circulation infarction （ TACI ） and posterior circulation infarction （ POCI ）. Methods：There were 62 patients of acute cerebral infarction who were divided into TACI group （44 cases ） and POCI group （18 cases）. The TACI group were given the intra-artery thromob01ytic therapy within 6h onset of stroke and the POCI group were within 12 h. A contrast of the NIHSS score and Barthel Index （BI） were made before treatment and on the different time after treatment. And the revascularization rate and prognosis were analyzed between different type, responsible artery and time window. Results： （ 1 ） There was a significant difference between before and after the treatment in the TACI group and the POCI group by all the NIHSS and BI （ P 〈 0.05 ）. And the NIHSS and BI of the TACI group were superior than the POCI （ P 〈 0.05 ）. （2） In the TACI group, the revascularization rate of the 0 - 4.5 h subgroup was higher than the 4.5 - 6 h subgroup（ P 〈 0.05 ）. And in the POCI group, the revascularization rate of the 0 -9 h subgroup was higher than the 9 - 12 h subgroup （P 〈 0.05 ）. In all the subgroups, there is significant difference between before and after the treatment （P 〈 0. 05 ）. （3）The revascularization rate of the atherosclerotie subgroup was higher than the cardio embolism subtype（ P 〈0.05）. Conclusion： The intra-artery thrombolytic therapy is effective and safe in both the anterior circulation infaction and posterior circulation infaction. The efficacy in TACI is superior than in POCI. The revascularization rate is different from responsible artery. And the therapy of the atherosclerotic subgroup is better than the the cardio embolism subtype. We shoule be active in treating the POCI for its more severity. And if necessary,we should give the intra-artery thrombolytic therapy as soon as possible.