2种急性前循环缺血性脑卒中动脉内治疗方式的比较

Comparison of two kinds of therapies in acute anterior circulation stroke patients

目的分析急性前循环闭塞患者动脉内治疗的效果及预后。方法回顾性分析北京军区总医院采用动脉内治疗的59例急性前循环闭塞患者的临床和随访资料，采用美国国立卫生院脑卒中量表（NIHSS）评价患者病情、改良Rankin评分（mRS）评估发病3个月后的恢复情况，并分析预后相关因素。采用t检验或卡方检验进行统计学分析，并行Logistic回归分析。结果患者平均年龄（59．8±1．3）岁，术中采用动脉溶栓25例和多模式溶栓治疗34例，2组患者平均入院NIHSS分别为12．6±4．3、18．3±4．2，发病时间分别为（5．3±0．9）h、（5．8±1．4）h，再通率分别为56．0％、82．4％，差异均有统计学意义（P〈0．05）。Logistic回归分析显示患者3个月后残障程度与年龄、初治时间、出院NIHSS评分和良好再通率相关。结论相比于动脉溶栓，多模式溶栓适用于较为严重或入院时间较长的患者。且再通率高。良好的血管再灌注是急性缺血性脑卒中患者获得较好预后的关键因素。

Objective To explore the intra-arterial therapies and prognostic predictors of anterior circulation stroke patients. Methods Fifty-nine anterior circulation stroke patients, admitted to our hospital from May 2011 to June 2014, were divided into two groups： intra-arterial therapy （IAT） group （n=25, thrombolysis in myocardial infarction [TIMI] grade II-III after IAT） and multi-modal therapy （MMT） group （n=34, onset time longer than 6 h or achieving no good effect after IAT）; their clinical data and follow up data were reviewed and summarized. National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the severity; and modified Rankin scale （mRS） was performed three months after the stroke to reveal the clinical outcomes. The t test, chi-square test and multivariable Logistic regression analysis were performed to analyze the related prognosis factors. Results The mean age of the patients was 59.8±1.3 years. MMT patients had significantly higher baseline admission NIHSS scores as compared with those in IAT patients （18.3±4.2 vs. 12.6±4.3, t=11.88, P=0.000）; MMT patients had a significantly higher patent flow rate as compared with [AT patients （82.4% vs. 56.0%, χ^2=4.878, P=0.027）. Besides, the MMT patients had a significantly longer time till accepting treatment （5.8±1.4 vs. 5.3±0.9, t=4.735, P=0.000）; In multivariate analysis, age, time getting treatment, NIHSS scores at discharge are predictors for poor outcomes, while perfect recanalization was associated with favorable outcome. Conclusions MMT can be used for patients with severe admission NIHSS scores, and it may enjoy higher patency rate than IAT. Good vessel recanalization is the only predictor for favorable outcome.