急性基底动脉闭塞早期溶栓的临床预后分析

Early clinical prognosis of thrombolysis treatment in acute basilar artery occlusion

目的探讨早期静脉溶栓治疗急性基底动脉闭塞(BAO)的疗效及预后。方法回顾性分析2012年1月—2014年2月期间住院部收治的52例行静脉溶栓治疗急性基底动脉闭塞患者的临床资料,分析溶栓效果、临床治疗效果、预后情况,同时探析治疗前神经功能障碍严重程度和溶栓时间窗对预后的影响。结果静脉溶栓治疗后完全再通率为63.46%,溶栓后NIHSS评分(12.55±3.68)分,明显低于治疗前(20.58±2.64)分(t=12.7854,P=0.0000);治愈率为67.31%,6例(11.54%)溶栓后出现脑出血、消化道出血等并发症,无一例死亡;静脉溶栓时间≤180 min者预后良好率82.61%,明显高于静脉溶栓时间>180 min者的预后良好率(44.83%)(χ2=7.7357,P=0.0054);NIHSS评分≤20分者预后良好率为90.91%,明显高于NIHSS评分>20分者预后良好率40.00%(χ2=13.8982,P=0.0002);溶栓后90 d BI指数评分优良率为84.62%。结论静脉溶栓血管再通率较高,能显著改善患者的神经功能,临床治疗效果满意、并发症发生率低,预后良好且显著改善患者的生活质量,可作为临床治疗急性基底动脉闭塞的首选方案。

Objective To analyze efficacy and prognosis of early Intravenous thrombolysis interventional treatment of acute basilar artery occlusion（ BAO） and to provide reference for future clinical treatment of BAO thrombolytic scheme selection,improve the prognosis and quality of life. Methods A retrospective analysis of 52 patients,who received routine arterial thrombolytic therapy,was performed in our hospital from 2012 January to February 2014. Clinical data of acute occlusion of the basilar artery thrombolysis effect,clinical treatment,prognosis,and treatment effect of anterior neural dysfunction severity and the prognosis of thrombolysis time window were analyzed. Results Artery recanalization rate after thrombolytic therapy was 63. 46%. NIHSS score after thrombolysis（ 12. 55 ± 3. 68） points was lower than that before treatment（ 20. 58 ± 2. 64） points（ t = 12. 7854,P = 0. 0000）. The cure rate was 67. 31%. 6 cases（ 11. 54%） had complications after thrombolysis including cerebral hemorrhage and gastrointestinal hemorrhage. There were no death cases. Intravenous thrombolysis time less than 180 min good prognosis rate of 82. 61% was significantly higher than intravenous thrombolysis time 180 min good prognosis of 44. 83%（ χ^2= 7. 7357,P = 0. 0054）. NIHSS score less than 〉20 points good prognosis rate of 90. 91% was significantly higher than NIHSS score 20 points good prognosis of 40. 00%（ χ^2= 13. 8982,P =0. 0002）; 90 d after thrombolysis BI index score the excellent and good rate was 84. 62%. Conclusion Intra arterial thrombolytic recanalization rate is higher and can significantly improve the neurological function of patients with satisfactory curative effect and low incidence of complications. The prognosis is good and improving the quality of life of patients is significant. It can be used as the preferred scheme of clinical treatment of acute basilar artery occlusion.