动静脉联合溶栓及机械取栓治疗急性脑梗死的效果

Therapeutic effects of combined intravenous and intra-arterial thrombolysis and mechanical thrombectomy for the treatment of acute cerebral infarction

目的探讨动静脉联合溶栓及机械取栓治疗急性脑梗死(ACI)疗效及对患者预后的影响。方法筛选2016年6月至2017年6月收治的大动脉闭塞ACI患者100例,随机分为对照组和研究组,各50例。对照组采用尿激酶经外周静脉及经股动脉插入指引导管至病变处实现动静脉联合溶栓;研究组经股动脉置入微导管支架行机械取栓。采用Barthel指数比较两组患者的临床疗效,采用美国国立卫生研究院卒中量表(NIHSS)神经功能缺损评分评价两组患者的预后。结果研究组患者治疗总有效率高于对照组(100.0%vs 88.0%,P<0.05)。研究组患者术后血管再通率、≤30%血管残余狭窄率均高于对照组(96.0%vs 74.0%,50.0%vs 18.0%,P均<0.01);两组24 h内颅内出血率、3个月内病死率比较差异无统计学意义(P均>0.05)。两组患者治疗前NIHSS评分比较差异无统计学意义(P>0.05),治疗后NIHSS神经功能缺损评分均低于治疗前,治疗后2周低于治疗后1周(P均<0.05);研究组治疗后1周、2周NIHSS神经功能缺损评分均低于对照组(P均<0.05)。结论机械取栓治疗ACI患者的疗效优于动静脉联合溶栓,在改善血管再通及狭窄率方面具有优势,且近远期临床预后均好。

Objective To investigate the efficacy of combined intravenous and intra-arterial thrombolysis and mechanical thrombectomy for the treatment of acute cerebral infarction（ ACI） and the impact on the prognosis of patients. Methods A total of 100 ACI patients with artery occlusion admitted from June 2016 to June 2017 were selected. The patients were randomly divided into control group and research group（ n = 50 each）. In control group,urokinase was administered through peripheral vein and through femoral artery in which the guide catheter was inserted into the lesionsite for performing combined intravenous and intra-arterial thrombolysis. In research group,the micro-catheter stent was implanted through femoral artery for mechanical thrombectomy. The clinical efficacy assessed by Barthel Index and the prognosis assessed by neurological deficit score of National Institutes of Health Stroke Scale（ NIHSS） were compared between two groups. Results The total effective rate in research group was significantly higher than that in control group（ 100% vs 88. 0%,P〈0. 05）. The postoperative vascular recanalization rate and vascular residual stenosis rate less than or equal to 30% in research group were significantly higher than those in control group（ 96. 0% vs 74. 0%,50. 0% vs 18. 0%,all P〈0. 01）.There were no significant differences in intracerebral hemorrhage rate within 24 hours and mortality within 3 months between two groups（ all P〉0. 05）. The neurological deficit scores of NIHSS after treatment in two groups were significantly lower than those before treatment,and they significantly lower at 2-week after treatment than those at 1-week after treatment in two groups（ all P〈0. 05）. There was no significant difference in theneurological deficit scores of NIHSS score before treatment in two groups（ P〉0. 05）. The neurological deficit scores of NIHSS at 1-and 2-week after treatment in researchgroup were all significantly lower than those in control group（ all P〈0. 05）. Conclusions The efficacy of mechanical thrombectomy is superior to combined intravenous and intra-arterial thrombolysis in the treatment of ACI.Mechanical thrombectomy has the advantages of improvement of vascular recanalization and stenosis rate and better shortterm and long-term clinical prognosis.