3种溶栓方案对急性大脑中动脉闭塞性脑梗死患者近远期疗效及并发症的影响

The curative effect and complications of three kinds of thrombolytic therapy on the patients with acute middle cerebral artery occlusion cerebral infarction

目的研究静脉溶栓、颈内动脉溶栓和血栓内接触性溶栓3种溶栓方案对急性大脑中动脉闭塞性脑梗死患者近远期疗效及并发症的影响。方法选择2014年1月至2016年3月在该院接受溶栓治疗的急性脑梗死患者120例。用随机数表法分为3组,A组(静脉溶栓)40例,B组(颈内动脉溶栓)40例,C组(血栓内接触性溶栓)40例。比较3组患者的美国国立卫生院卒中量表(NIHSS)评分、临床疗效、并发症和再通率。结果治疗前3组患者的NIHSS评分差异无统计学意义(P>0.05);治疗后2h、治疗后24h、治疗后7d,B组患者的NIHSS评分低于A组患者,C组患者的NIHSS评分低于其他两组,差异有统计学意义(P<0.05)。C组患者的总有效率为87.50%,B组患者的总有效率为77.50%,A组患者的总有效率为67.50%,3组比较差异有统计学意义(P<0.05)。C组患者的总出血率为10.00%,B组患者的总出血率为15.00%,A组患者的总出血率为12.50%,3组比较差异无统计学意义(P>0.05)。C组患者的再通率为85.00%,B组患者的再通率为75.00%,A组患者的再通率为62.50%,3组比较差异有统计学意义(P<0.05)。结论急性大脑中动脉闭塞性脑梗死患者应用血栓内接触性溶栓起效快、效果好,动脉溶栓的效果优于静脉溶栓。

Objective To study the curative effect and complications of intravenous thrombolysis,internal carotid artery thrombolysis and blood clots in contact thrombolysis three kinds of thrombolytic therapy on the patients with acute middle cerebral artery occlusion cerebral infarction.Methods A total of 120 patients with acute cerebral infarction who treated in our hospital were selected from January 2014 to March 2016.They were divided into three groups with the random number table method,40 cases in A group（intravenous thrombolysis）,40 cases in group B（internal carotid artery thrombolysis）,40 cases in group C（thrombus contact thrombolysis）.The NIHSS score,clinical efficacy,complications and re-pass rate of the three groups were compared.Results Before treatment,NIHSS scores of three groups of patients didn′t have statistical significance（P〈0.05）.Treatment after 2 h,treatment after 24 hand treatment after 7 d,NIHSS score of group B was significantly lower than that of group A,and which of group C was lower than the other two groups,the difference had statistical significance（P〈0.05）.Total efficiency of group C,B and A was 87.50%,77.50% and 67.50%,the difference between the three groups had statistical significance（P〈0.05）.Bleeding rate of group C,B and A was 10.00%,15.00% and 12.5%,the difference had no statistical significance（P〈0.05）.The rate of re-pass of group C,B and A was 85.00%,75.00% and 62.50%,the difference had statistical significance（P〈0.05）.Conclusion Patients with acute middle cerebral artery occlusion cerebral infarction use blood clots in contact thrombolysis has good effect,and the effect of the artery thrombolysis is better than intravenous thrombolysis.