动脉溶栓与机械碎栓联合动脉溶栓的对比分析

Comparison of the therapeutic efficacy between simple arterial thrombolysis and mechanical thrombectomy combined with arterial thrombolysis for acute cerebral infarction at its ultra-early stage

目的比较两种不同动脉溶栓方法治疗超早期脑梗死患者的疗效,探讨哪种方法更有益于开通血管。方法收集2009年10月-2011年5月55例脑梗死急性期并行超早期介入治疗患者,其中25例(联合治疗组)采用机械碎栓联合尿激酶进行动脉内溶栓治疗,30例(尿激酶组)采用尿激酶进行单纯动脉内溶栓治疗。术后观察患者闭塞血管再通和神经功能障碍恢复情况,并比较分析两种动脉溶栓方法的疗效。结果联合治疗组患者血管再通23例,成功再通率为92%(23/25),尿激酶组患者则为18例,再通成功率仅为60%(18/30)。术后平均NIHSS(脑卒中量表)及ADL(日常活动量表)评分联合治疗组(1 h分别为8.6±2.5和20.0±4.6;24 h分别为9.0±1.8和17.0±2.5)改善程度明显优于尿激酶组(1 h分别为7.5±2.0和28.0±3.5;24 h分别为8.1±2.0和24.O±2.1),两组间差异有统计学意义(P<0.05)。尿激酶用量及溶栓时间联合治疗组分别为(36.8±8.4)万u和(35.3±11.6)min,尿激酶组分别为(50.4±15.3)万u和(55.7±13.3)min,前者低于后者,两组间差异有统计学意义(P<0.05)。结论超早期应用动脉内机械碎栓联合动脉溶栓治疗急性脑梗死的疗效优于单纯动脉溶栓。

Objective To compare the therapeutic efficacy between the simple arterial thrombolysis and mechanical thrombectomy combined with arterial thrombolysis in treating acute cerebral infarction at its ultra-early stage, and to determine the optimal method more beneficial to endovaseular recanalization. Methods During the period from Oct. 2009 to May 2011, emergency interventional therapy was carried out in 55 patients with acute cerebral infarction at its uhra-early stage. Arterial thrombolysis using urokinase combine with mechanical thrombectomy was employed in 25 patients （combination group）, while pure arterial infusion of urokinase was adopted in 30 patients （urokinase group）. After the treatment, the vascular recanalization and the recovery of the dysneuria were estimated, and the thrombolysis efficacy was compared between the two methods. Results The vascular reeanalization rate in combination group and urokinase group were 92% （23/25） and 60% （18/30）, respectively. After the treatment, the one-hour NIHSS and ADL scores of the combination group were 8.6± 2.5 and 20.0± 4.6, respectively, while the 24-hour NIHSS and ADL scores of the combination group were 9.0 ±1.8 and 17.0 ± 2.5, respectively, both of which were significantly better than those of the urokinase group （P 〈 0.05）. The dosage of urokinase and the time of thrombolysis in combination group were （36.8 ± 8.4） ×104 units and （35.3 ± 11.6） minutes, respectively. The dosage of urokinase and the time of thrombolysis in urokinase group were （50.4 ±15.3） × 104 units and （55.7± 13.3） minutes, respectively. Statistically significant difference existed between the two groups （P 〈 0.05）. Conclusion The emergency use of mechanical thrombectomy combined with arterial thrombolysis isvery effective for acute cerebral infarction at its uhra-early stage, and its therapeutic efficacy is superior to that of pure arterial infusion of urokinas.