尿激酶静脉溶栓与动脉溶栓治疗急性脑梗死的效果及安全性分析

Efficacy and Safety of Intravenous Thrombolysis and Arterial Thrombolysis with Urokinase in Treatment of Patients with Acute Cerebral Infarction

目的分析分别应用尿激酶静脉溶栓与动脉溶栓对急性脑梗死患者的治疗效果及安全性。方法回顾性分析2016年1月-2018年1月接受治疗的86例急性脑梗死患者。根据溶栓治疗途径的不同分为对照组和观察组,每组43例。对照组应用尿激酶静脉溶栓,观察组应用尿激酶动脉溶栓。对比2组溶栓前、溶栓1周时血清簇集蛋白(CLU)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平以及血管再通率,并在溶栓30d后对2组采用改良的Rankin量表(mRS)评分判断疗效,比较致死率与出血事件发生率。结果溶栓1周时,2组的CLU、hs-CRP、TNF-α、IL-6水平均较溶栓前下降,且观察组比对照组下降幅度更大(P<0.05)。观察组血管再通率和总有效率均高于对照组,mRS评分低于对照组(P<0.05)。2组致死率、颅内出血和其他部位出血发生率比较差异均无统计学意义(P>0.05)。结论尿激酶动脉溶栓对急性脑梗死患者疗效更明显,且安全性较高。

Objective To analyze efficacy and safety of intravenous thrombolysis and arterial thrombolysis with Urokinase in treatment of patients with acute cerebral infarction. Methods A total of 86 patients with acute cerebral infarction admitted during January 2016 and January 2018 were divided into control group and observation group ( n =43 in each group) according to different methods of thrombolytic therapy. Control group was treated with intravenous thrombolysis with Urokinase, while observation group was treated with arterial thrombolysis with Urokinase. Serum levels of cluster protein (CLU), high sensitive C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), Interleukin-6 (IL-6) and vascular recanalization rate were compared before and after thrombolysis for 1 week between two groups. Curative effect was evaluated by modified Rankine scale (mRS) at 30 d after thrombolysis, and mortality rate and incidence rate of bleeding events were compared in two groups. Results At the time of thrombolysis for one week, levels of CLU, hs-CRP, TNF-α and IL-6 were significantly lower than those before thrombolysis in two groups, and the decreased values in observation group were greater than those in control group ( P <0.05). In observation group, vascular recanalization rate and the total effective rate were significantly higher, while mRS score was significantly lower than those in control group ( P <0.05). There were no significant differences in incidence rates of mortality, intracranial hemorrhage and other bleeding between two groups ( P >0.05). Conclusion Urokinase arterial thrombolysis may be more effective and safe in treatment of patients with acute cerebral infarction.