抗凝、静脉溶栓及动静脉联合溶栓在后循环缺血性卒中患者中应用效果的比较研究

Comparative Study for Application Effect of Anticoagulation,Intravenous Thrombolysis and Intravenous Combined with Intra-arterial Thrombolysis in Treating Posterior Circulation Ischemic Stroke

目的比较抗凝、静脉溶栓及动静脉联合溶栓在后循环缺血性卒中患者中的应用效果。方法连续选取2012年1月—2014年1月于中国人民解放军第313医院就诊的急性后循环缺血性卒中患者100例,根据治疗方法分为抗凝组50例、静脉溶栓组36例及动静脉联合溶栓组14例。抗凝组患者给予低分子肝素钠,静脉溶栓组患者给予重组人组织型纤溶酶原激活剂,动静脉联合溶栓组患者给予动静脉联合溶栓。比较3组患者治疗后24 h、7 d、14 d有效率、美国国立卫生研究院卒中量表（NIHSS）评分、治疗前及治疗后24 h、7 d、14 d血浆溶血磷脂酸水平。结果静脉溶栓组、动静脉联合溶栓组患者治疗后24 h、7 d、14 d有效率高于抗凝组（P〈0.05）;而静脉溶栓组与动静脉联合溶栓组患者治疗后24 h、7 d、14 d有效率比较,差异无统计学意义（P〉0.05）。静脉溶栓组、动静脉联合溶栓组患者治疗后24 h、7 d、14 d NIHSS评分低于抗凝组,动静脉联合溶栓组治疗后24 h、7 d、14 d NIHSS评分低于静脉溶栓组（P〈0.05）。3组患者治疗前血浆溶血磷脂酸水平比较,差异无统计学意义（P〉0.05）;静脉溶栓组、动静脉联合溶栓组患者治疗后24 h、7 d、14 d血浆溶血磷脂酸水平低于抗凝组（P〈0.05）;而静脉溶栓组与动静脉联合溶栓组患者治疗后24 h、7 d、14 d血浆溶血磷脂酸水平比较,差异无统计学意义（P〉0.05）。结论对于时间窗为3~12 h的后循环缺血性卒中患者,动静脉联合溶栓治疗效果最佳,其次为静脉溶栓与抗凝治疗,但动静脉联合溶栓出血风险增加。

Objective To compare the application effect of anticoagulation,intravenous thrombolysis and intravenous combined with intra- arterial thrombolysis in treating posterior circulation ischemic stroke. Methods A total of 100 patients with posterior circulation ischemic stroke were selected in the 313 rd Hospital of the Chinese People＇s Liberation Army from January2012 to January 2014,and they were divided into A group（ n = 50）,B group（ n = 36） and C group（ n = 14） according to therapeutic methods. Patients of A group received low- molecular- weight heparin sodium for anticoagulation, patients of B group received rt- PA for intravenous thrombolysis, and patients of B group received intra- arterial thrombolysis based on intravenous thrombolysis. The effective rate and NIHSS score after 24 hours, 7 days and 14 days of treatment, plasma lysophosphatidic acid level before treatment and after 24 hours,7 days,14 days of treatment were compared among the three groups. Results The effective rate of B group and C group was statistically significantly higher than that of A group after 24 hours,7 days and 14 days of treatment,respectively（ P〈 0. 05）,while no statistically significant differences of effective rate was found between B group and C group after 24 hours,7 days or 14 days of treatment（ P 〉0. 05）. NIHSS score of B group and C group was statistically significantly lower than that of A group after 24 hours,7 days and 14 days of treatment,respectively,and NIHSS score of C group was statistically significantly lower than that of B group after 24 hours,7 days and 14 days of treatment,respectively（ P〈 0. 05）. No statistically significant differences of plasma lysophosphatidic acid level was found among the three groups before treatment（ P〉 0. 05）; after 24 hours,7 days,14 days of treatment,plasma lysophosphatidic acid level of B group and C group was statistically significantly lower that of A group, respectively（ P 0. 05）, while no statistically significant differences of plasma lysophosphatidic acid level was found between B group and C group（ P 0. 05）.Conclusion In posterior circulation ischemic stroke patients within 3 to 12 hours of time- window,intravenous combined with intra- arterial thrombolysis has the best clinical effect,secondly is intravenous thrombolysis and anticoagulation,but the risk of hemorrhage of intravenous combined with intra- arterial thrombolysis is relatively high.