微创方案治疗急性椎基底动脉闭塞性脑梗死临床研究

Clinical study on minimally invasive treatment of patients with cerebral infarction after acute vertebrobasilar oc -clusion

目的 探讨静脉溶栓 、动脉溶栓及机械取栓方案对急性椎基底动脉闭塞性脑梗死患者近远期疗效及安全性的影响.方法 选取焦作煤业集团中央医院2016-01-2018-01收治急性椎基底动脉闭塞性脑梗死患者共135例,以随机数字表法分为A组(45例)、B组(45例)及C组(45例),分别采用静脉溶栓 、动脉溶栓及机械取栓方案治疗,比较3组血管再通率 、NIHSS评分改善良好率 、随访预后改善率 、随访病死率及颅内症状性出血发生率.结果 C组血管再通率和NIHSS评分改善良好率均显著高于A组 、B组(P<0.05);B组血管再通率和NIHSS评分改善良好率均显著高于A组(P<0.05);C组随访预后改善率显著高于A组 、B组(P<0.05);3组随访病死率比较差异无显著性(P>0.05);同时C组术后颅内症状性出血发生率显著低于A组 、B组(P<0.05).结论 机械取栓方案治疗急性椎基底动脉闭塞性脑梗死在近远期疗效和安全性方面均显著优于静脉溶栓 、动脉溶栓,更具临床应用价值.

Objective To investigate the influence of arterial thrombolysis,venous thrombolysis and thrombectomy on clinical efficacy for short term and long term and safety of patients with cerebral infarction after acute vertebrobasilar occlusion.Methods 135 patients with cerebral infarction after acute vertebrobasilar occlusion in the period from January 2016 to January 2018 in our hospital were chosen and randomly divided into both group including A group(45 patients)with venous thrombolysis,B group(45 patients)with arterial thrombolysis and C group(45 patients)with thrombectomy;and the blood vessel recanalization rate,good and excellent rate of NIHSS score improvement,the improvement rate of prognosis with follow up,the mortality with follow up and intracranial symptomatic hemorrhage rate of 3 groups were compared.Results The blood vessel recanalization rate and good and excellent rate of NIHSS score improvement of C group were significantly higher than A group and B group(P<0.05).The blood vessel recanalization rate and good and excellent rate of NIHSS score improvement of B group were significantly higher than A group(P<0.05).The improvement rate of prognosis with follow up of C group were significantly higher than A group and B group(P<0.05).There was no significant difference in the mortality with follow up between 2 groups(P>0.05).The intracranial symptomatic hemorrhage rate of C group were significantly lower than A group and B group(P<0.05).Conclusion Compared with arterial thrombolysis and venous thrombolysis,thrombectomy in the treatment of patients with cerebral infarction after acute vertebrobasilar occlusion can efficiently improve clinical efficacy for short term and long term and higher treatment safety.