急诊机械取栓治疗阿替普酶静脉溶栓无效急性中重度脑梗死的效果

Effect of emergency mechanical thrombectomy in the treatment of acute moderate to severe cerebral infarction after failure of intravenous infusion of Alteplase

目的探讨急诊机械取栓治疗阿替普酶静脉溶栓无效急性中重度脑梗死的效果。方法选取我院2016年2月～2018年2月收治的60例急性中重度脑梗死患者作为研究对象,按照随机数字表法分为对照组(30例)和观察组(30例)。对照组静脉阿替普酶溶栓治疗后血管无再通,且24 h后CT检查排除继发脑出血,继续进行调脂抗栓等对症治疗,观察组行静脉阿替普酶溶栓后血管无再通,进行急诊机械取栓治疗,且24 h后CT检查排除继发脑出血,继续进行调脂抗栓等对症治疗。比较治疗前后14、28 d的Barthel指数,美国国立卫生研究院卒中量表(NIHSS)评分,治疗后并发症发生情况。结果治疗前,两组的Barthel指数、NIHSS评分比较,差异无统计学意义(P>0.05);观察组治疗后14、28 d的Barthel指数高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论急诊机械取栓治疗静脉阿替普酶溶栓无效的急性中重度脑梗死的效果乐观,值得在临床大力推广应用。

Objective To investigate the effect of emergency mechanical thrombectomy in the treatment of acute moderate to severe cerebral infarction after failure of intravenous infusion of Alteplase. Methods Sixty patients with acute moderate to severe cerebral infarction admitted to our hospital from February 2016 to February 2018 were enrolled in the study. They were divided into control group (n=30) and observation group (n=30) according to random number table method. In the control group, after the treatment of intravenous Alteplase thrombolytic therapy, the blood vessels were not recanalized. After 24 hours, the secondary cerebral hemorrhage was excluded by CT examination, and symptomatic treatment such as lipid-lowering and anti-thrombosis was continued. In the observation group, after failure of intravenous Alteplase thrombolytic therapy, emergency mechanical thrombectomy was performed. After 24 hours, secondary cerebral hemorrhage was excluded by CT examination, and symptomatic treatment such as lipid-lowering and anti-thrombosis was continued. The Barthel index, national institutes of health stroke scale (NIHSS) score, and post-treatment complications before and after treatment at 14 d and 28 d were compared in the two groups. Results Before treatment, there were no significant difference in Barthel index and NIHSS score between the two groups (P>0.05). The Barthel index of the observation group was higher than that of the control group after treatment, and the NIHSS score was lower than the control group at 14 d and 28 d with statistical significance (P<0.05). The incidence of complications in the two groups did not display statistically significant (P>0.05). Conclusion Emergency mechanical thrombectomy in the treatment of acute moderate to severe cerebral infarction after failure of intravenous Alteplase thrombolysis can obtain a favorable effect and is worthy of extensive promotion in clinical practice.