急性脑梗死患者rt-PA静脉溶栓及桥接血管内治疗的临床效果比较

Comparative study on the clinical effects of rt-PA intravenous thrombolysis and intravascular therapy in pa⁃tients with acute cerebral infarction

目的探究急性脑梗死患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓及桥接血管内治疗的临床效果。方法选择急性脑梗死患者254例,根据治疗方式不同分为rt-PA静脉溶栓治疗(静脉溶栓组)167例与静脉溶栓桥接血管内治疗组87例。观察两组患者治疗后血管再通情况,治疗后24 h、14 d神经功能改善情况及临床治疗效果,并随访3个月,观察预后情况。结果静脉溶栓桥接血管内治疗组血管再通率(91.95%)明显高于静脉溶栓组(52.69%),差异有统计学意义(χ^2=39.37,P<0.05);治疗前两组患者美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(t=0.38,P>0.05),治疗后24 h、14 d静脉溶栓桥接血管内治疗组NIHSS评分均明显低于静脉溶栓组,差异均有统计学意义(t分别=3.85、4.68,P均<0.05);静脉溶栓桥接血管内治疗组总有效率(89.66%)明显高于静脉溶栓组(74.25%),差异有统计学意义(χ^2=8.34,P<0.05);静脉溶栓桥接血管内治疗组mRS良好率(67.82%)明显高于静脉溶栓组(37.72%),差异有统计学意义(χ^2=20.75,P<0.05)。结论rt-PA静脉溶栓可有效改善急性脑梗死患者预后,若考虑大血管闭塞,桥接血管内治疗可增加血管再通率,改善预后。

Objective To investigate the clinical effects of recombinant tissue plasminogen activator(rt-PA)in intravenous thrombolysis and intravascular therapy in patients with acute cerebral infarction.Methods Totally 254 patients with acute cerebral infarction were selected.Of which,167 patients received rt-PA intravenous thrombolytic therapy,87 patients received intravenous thrombolytic bridging intravascular therapy.After treatment,vascular recanalization,neurological improvement and clinical therapeutic effect were observed in patients of the two groups at 24h and 14d.And the patients were followed-up for 3 months to observe the prognosis.Results Vascular recanalization rate in intravenous thrombolytic bridge treatment group(91.95%)was significantly higher than intravenous thrombolysis group(52.69%),the difference was statistically significant(χ^2=39.37,P<0.05).There was no significant difference in NIHSS score between the two groups before treatment(t=0.38,P>0.05),while the NIHSS score in intravenous thrombolytic bridge treatment group at 24h and 14d after treatment was significantly lower than that in intravenous thrombolysis group(t=3.85,4.68,P<0.05).The total effective rate(89.66%)of the intravenous thrombolytic bridging intravascular treatment group was significantly higher than intravenous thrombolytic group(74.25%),the difference was statistically significant(χ^2=8.34,P<0.05).The good rate of mRS in the intravenous thrombolytic bridging intravascular treatment group(67.82%)was significantly higher than intravenous thrombolysis group(37.72%),the difference was statistically significant(χ^2=20.75,P<0.05).Conclusion rt-PA intravenous thrombolysis can effectively improving the prognosis of patients with acute cerebral infarction.If the occlusion of great vessels is taken into account,intravascular therapy can increase the vascular recanalization rate and improve the prognosis.