急性后循环脑梗死三种治疗方法的疗效比较

Efficacy comparison of three therapeutic approaches in patients with acute posterior-circulation infarction

目的 比较急性后循环脑梗死患者行静脉溶栓、动脉溶栓及基底动脉取栓联合支架植入术的治疗效果差异。 方法 对唐山市工人医院神经内科自2005年3月至2013年2月收治的57例急性后循环脑梗死患者,根据患者发病至入院时间分为3组,其中发病时间在6h以内者行静脉溶栓,发病时间为6～24h者行动脉溶栓,超过24h者行基底动脉取栓联合支架植入术。采用治疗前及治疗后24h、7d美国国立卫生研究院卒中量表（NIHSS）评分差值评估患者治疗效果,采用治疗后3个月改良Rankin量表（mRS）评分评价临床预后情况。 结果 3种方法在治疗后24 h、7d的有效率比较差异均有统计学意义（P＜0．05）,其中动脉溶栓的有效率明显高于静脉溶栓,基底动脉取栓联合支架植入术的有效率明显高于静脉溶栓和动脉溶栓。3种方法在治疗后3个月MRS评分比较差异有统计学意义（P＜0．05）,其中动脉溶栓的临床预后改善明显优于静脉溶栓,基底动脉取栓联合支架植入术的临床预后改善明显优于静脉溶栓和动脉溶栓。 结论 对于后循环脑梗死患者,应根据患者具体情况采取各种治疗方法,其中治疗时间窗较长者采用动脉取栓联合急诊支架植入术或许能更明显改善患者预后。

Objective To investigate the therapeutic effects of intravenous thrombolysis,intral-arterial thrombolysis,basilar artery embolectomy combined with stent implantation on patients with posterior-circulation infarction.Methods Fifty-seven patients with acute posterior circulation infarction （onset time within 6 to 72 h）,admitted to our hospital from March 2005 to February 2013,were chosen; All subjects were randomly divided into three groups：group A,accepted intravenous thrombolysis （within 6 h of onset）,group B,accepted intral-arterial thrombolysis （within 6-24 h of onset）,and group C,accepted basilar artery embolectomy and stent implantation （over 24 h of onset）.US National Institutes of Health Stroke Scale （NIHSS） was used to observe the clinical symptom improvement,and evaluate the results before and 24 h and 7 d after treatment.Three months after treatment,modified Rankin Scale （mRS） was employed to evaluate the clinical prognosis.Results Significant differences were noted in the treatment efficacy 24 h and 7 d after treatment among the three approaches （P〈0.05）：that in group B was obviously higher than that in group A; that in group C was obviously higher than that in group A and B.The mRS scores were significantly different among the three groups （P〈0.05）：the clinical outcome improvement in group B was obviously higher than that in group A; that in group C was obviously higher than that in group A and B.Conclusion Different treatments should be adopted based on the specific circumstances of the patients; for those with long time window of thrombolysis,basilar artery embolectomy combined with stent implantation might be more effective in improving the prognosis of the patients.