不同方法治疗急性大脑中动脉M2段闭塞效果

目的对比常规治疗、经静脉溶栓和血管内治疗对急性大脑中动脉M2段(MCA-M2)闭塞的临床疗效。方法76例急性MCA-M2闭塞患者分别接受常规治疗(常规组,n=31)、静脉溶栓治疗(溶栓组,n=27)和血管内治疗(血管内组,n=18),比较3组疗效相关指标。结果治疗后24 h,血管内组美国国立卫生研究院卒中量表(NIHSS)评分较基线下降≥4分者占比(83.33%)显著高于常规组(48.15%,校正前及校正后P均<0.01)。随访90天,相比常规组,溶栓组和血管内组良好预后率均提高、死亡率均降低,非症状性颅内出血发病率增加(校正前P均<0.05);经年龄、基线NIHSS评分、发病至入院时间校正后差异均无统计学意义(P均>0.05)。溶栓组1例出现症状性颅内出血。血管内组血管再通率94.44%。结论对于MCA-M2闭塞性急性脑梗死患者,急诊血管内治疗安全、有效,可早期快速改善神经功能。

Effect of different treatments for acute middle cerebral artery M2 occlusion

Objective To observe and compare the clinical efficacy of conventional therapy,intravenous thrombolysis and endovascular therapies of acute ischemic stroke with M2 segment of middle cerebral artery(MCA-M2)occlusions.Methods Data of 76 acute MCA-M2 occlusion patients who received conventional therapy(conventional therapy group,n=31),intravenous thrombolysis(thrombolysis group,n=27)or endovascular therapy(endovascular therapy group,n=18)were retrospectively analyzed.The relevant clinical efficacy indicators were compared among 3 groups.Results Twenty-four hours after treatments,the proportion of falling National Institutes of Health stroke scale(NIHSS)≥4 in endovascular therapy group(83.33%)was significantly higher than in conventional therapy group(48.15%,both unadjusted and adjusted P<0.01).During 90-day follow-up,compared with those of conventional therapy group,the good prognosis rate and the incidence of asymptomatic intracranial hemorrhage increased in both thrombolysis group and endovascular therapy group,while the mortality rate decreased(unadjusted P<0.05),but no statistical difference was found after adjustment for age,baseline NIHSS score and time from onset to admission(all P>0.05).Symptomatic intracranial hemorrhage occurred in 1 case of thrombolysis group.The vascular recanalization rate in endovascular therapy group was 94.44%.Conclusion For patients with MCA-M2 occlusive acute cerebral infarction,emergency endovascular therapies were safe and effective,which could rapidly and early improve neurological deficit.