动脉溶栓治疗后循环急性脑梗死与静脉溶栓的回顾分析

Historical Control Study on the Effect of Intra-arterial Thrombolysis and Intra-venous Thrombolysisin Patients with Posterior Circulation Cerebral Infarction

目的研究动脉溶栓治疗后循环急性脑梗死的术后即刻疗效和短期预后。方法选择2013年4月-2015年1月在我院采用尿激酶行责任血管动脉溶栓的患者39例为动脉溶栓组（IAT组）,回顾2010年7月-2013年3月在我院采用rt-PA行静脉溶栓的患者34例为静脉溶栓组（IVT组）作为对照,比较两组病死率以及治疗前、后以及3 m后NIHSS评分。结果与治疗前比较,IVT组和IAT组治疗后即刻以及治疗后3 m NIHSS评分均显著减低;与治疗后即刻比较,两组治疗后3 m NIHSS评分均显著减低。与IVT组比较,治疗后即刻以及治疗后3 m IAT组NIHSS评分均显著减低。IVT组34例患者中16例（47.1%）于3 m内死亡,IAT组39例患者中7例（17.9%）于3 m内死亡,两组比较具有统计学差异（P=0.008）。IVT组并发出血4例（10.3%）,IAT组3例（8.8%）,两组比较无统计学差异（P=0.836）。结论后循环急性脑梗死患者动脉溶栓治疗后病死率、溶栓后即刻及3 m后神经功能评估均优于静脉溶栓治疗。

Objective To investigate the immediate effect and short-term prognosis in patients with acute posterior circulation cerebral infarction after Intra-arterial thrombolysis. Methods From April 2013 to January 2015,39 consecutive acute posterior circulation cerebral infarction patients had intra-arterial thrombolysis treatment（ group IAT）. The clinical data of 34 cases of acute posterior circulation cerebral infarction treated by intravenous rt-PA thrombolysis from January July2013 to March 2010 were analyzed retrospectively（ group IVT）. The NIHSS scores and mortality were compared between two groups before and after treatment immediately and at 3 months. Results As compared with pre-treatment,The the NIHSS scores after treatment immediately were significantly improved and were further improved after 3 months in two groups（ P〈0. 05,respectively）. The NIHSS scores after treatment immediately and 3 months were significantly improved in group IAT as compared with group IVT（ P〈0. 05,respectively）. Compared with the group IVT,group IAT had significantly lower mortality（ 17. 9% vs 47. 1%,P〈0. 05）. There was no significant difference in hemorrhage complication between the two groups（ 8. 8% vs 10. 3%,P = 0. 836）. Conclusion Intra-arterial thrombolysis treatment of posterior circulation cerebral infarction can decrease mortality. The improvement of NIHSS scores through Intra-arterial thrombolysis are superior to those of intravenous rt-PA thrombolysis.