动脉溶栓和动静脉联合溶栓及机械取栓治疗急性脑梗死的对比分析

Arterial Thrombolysis,Arteriovenous Thrombolysis and Mechanical Thrombectomy for Acute Cerebral Infarction

目的:分析和对比动脉溶栓和动静脉联合溶栓及机械取栓治疗急性脑梗死的临床疗效。方法:选择笔者所在医院自2016年12月-2017年12月收治的60例急性脑梗死患者作为研究对象,将其随机分成a、b、c三组,每组20例,a组行动脉溶栓治疗,b组行动静脉联合溶栓治疗,c组行机械取栓治疗,对比三组治疗疗效。结果:c组血管再通率明显高于a、b两组,c组血管再通时间明显短于a、b两组,b组血管再通时间明显短于a组,组间对比差异有统计学意义(P<0.01或P<0.05),a、b两组再通率对比差异无统计学意义(P>0.05);治疗前,三组患者NIHSS评分差异无统计学意义(P>0.05),治疗后24 h,c组NIHSS评分明显低于a、b两组,b组明显低于a组,组间对比差异有统计学意义(P<0.01或P<0.05),治疗后30 d,c组NIHSS评分明显低于a、b两组,组间对比差异有统计学意义(P<0.01),但a、b两组间差异无统计学意义(P>0.05);治疗后,a、b两组前向血流1级以下的患者明显高于c组,c组前向血流2b级以上的患者明显高于a、b两组,差异有统计学意义(P<0.01);治疗期间,c组并发症发生率明显低于a、b两组,b组并发症发生率明显高于a组,组间对比差异有统计学意义(P<0.05),且a、b两组均出现了1例死亡病例,两组致死性并发症发生率差异无统计学意义(P>0.05)。结论:动脉溶栓、动静脉联合溶栓及机械取栓治疗急性大血管闭塞性脑梗死均有一定的疗效,但机械取栓治疗对患者神经缺损的改善效果更加明显,且并发症少。因此,机械取栓桥接静脉溶栓已日渐成为治疗急性大血管闭塞性脑梗死的首选方法。

Objective:To analyze and compare the clinical efficacy of arterial thrombolysis,arteriovenous thrombolysis and mechanical thrombectomy in the treatment of acute cerebral infarction.Method:60 patients with acute cerebral infarction treated in our hospital from December 2016 to December 2017 were selected as study subjects.They were randomly divided into three groups of a,b,and c,with 20 cases in each group.Arterial thrombolysis was performed in group a,group b was treated with arteriovenous thrombolysis,group c was treated with mechanical thrombectomy,and the efficacy of the three groups was compared.Result:The recanalization rate of group c was significantly higher than that of group a and b,the recanalization time of group c was significantly shorter than that of group a and b,the recanalization time of group b was significantly shorter than that of group a,the difference was significantly different(P<0.01 or P<0.05).There was no significant difference in the recanalization rate between group a and b(P>0.05).Before treatment,there was no significant difference in NIHSS score among the three groups(P>0.05).At 24 hours after treatment,the NIHSS scores in group c were significantly lower than those in groups a and b,and those in group b were significantly lower than those in group a,there was a significant difference between the three groups(P<0.01或P<0.05).After 30 days of treatment,NIHSS scores in group c were significantly lower than those in groups a and b,there was significant difference among groups(P<0.01),but there was no significant difference between groups a and b(P>0.05).After treatment,patients with grade 1 or less of blood flow were significantly higher in groups a and b than in group c.The patients with blood flow above grade 2b were significantly higher than those in groups a and b(P<0.01).During the treatment period,the incidence of complications in group c was significantly lower than that in groups a and b,and group b was significantly higher than group a,there was a significant difference among the three groups(P<0.05).There was one death case in both groups a and b,there was no significant difference in the mortality rate between the two groups(P>0.05).Conclusion:Arterial thrombolysis,arteriovenous thrombolysis and mechanical thrombectomy have a definite effect on the treatment of acute large-vessel occlusive cerebral infarction.Mechanical thrombectomy has a more noticeable effect on the improvement of neurological deficits and fewer complications.Therefore,mechanical thrombectomy bridging venous thrombolysis has gradually become the preferred method for the treatment of acute large-vessel occlusive cerebral infarction.