动脉内溶栓治疗大脑中动脉完全闭塞的临床分析

Intra-arterial thrombolysis for complete occlusion of middle cerebral artery: a clinical anaysis

目的评价动脉内溶栓治疗大脑中动脉闭塞的血管再通率及临床疗效。方法回顾性分析动脉内溶栓治疗大脑中动脉闭塞患者168例。根据溶栓药物分为尿激酶组122例,重组组织型纤溶酶原激活剂(rt-PA)组46例,通过数字减影血管造影(DSA)分析闭塞大脑中动脉再通率,采用Mori分级标准评价血管再通程度,格拉斯哥预后评分(GOS)评价患者预后。结果①尿激酶组:血管完全再通占37.7%(46/122);部分再通占46.7%(57/122);未通占15.6%(19/122),溶栓后脑出血占6.6%(8/122);预后恢复良好为51.6%(63/122),轻度残障22.1%(27/122)重度残障19.7(24/122),植物状态0.8%(1/122),死亡5.7%(7/122)。②rt-PA组:血管完全再通占41%(19/46);部分再通占52%(24/46);未通占6%(3/46),出血6%(3/46),恢复良好54%(25/46),轻度残障24%(11/46),重度残障15%(7/46),植物状态2%(1/46),死亡4%(2/46)。两组血管再通率、出血率及其GOS评分比较,差异无统计学意义,P>0.05。结论动脉内溶栓可有助于再通完全闭塞的大脑中动脉和改善患者预后。尿激酶和rt-PA溶栓效果相近。

Objective To evaluate the recanalization and its clinical efficacy of middle cerebral artery occlusion （MCAO） treated with intra-arterial thrombolysis. Methods The clinical data of 168 patients with MCAO treated with intra-arterial thrombolysis were analyzed retrospectively. Patients were divided into urokinase （n = 122） and recombinant tissue-type plasminogen activator （rt-PA） （n = 46） groups according to the different thrombolytics. The recanalization rate of the occluded MCAs was evaluated by digital subtraction angiography （DSA）. The degree of recanalization was evaluated by Mori grades, and the prognosis of patients was assessed by Glasgow Outcome Scale （GOS）. Results The total recanalization rate in the urokinase group was 84. 4% （103/122）. Among which complete recanalization was 37.7% （46/122）, partial recanalization was 46. 7% （57/122） ; and non-recanalization was 15.6% （19/122）. Bleeding after thrombolysis occured in 6. 6% （8/122）. The favorable prognosis was 51.6% （63/122）, and mild disability was 22. 1% （27/122）. The total recanalization rate in the rt-PA group was 94% （43/ 46）. Among which complete recanalization was 41% （19/46） ; partial recanalization was 52% （24/46） and non-recanalization was 6% （3/46）. Bleeding occured in 6% （3/46） after thrombolysis. The favorable prognosis was 54% （25/46）, and mild disability was 24% （11/46）. There were no significant differences between the two groups in the rate of recanalization, bleeding and their GOS scores. Conclusion Intra-arterial thrombolysis is helpful for recanalization of completely occluded MCA and improve the prognosis of patients. Thrombolysis with urokinase and rt-PA are similar results.