重组组织型纤溶酶原激活剂动脉溶栓联合血管内治疗对早期急性脑梗死的疗效观察

Clinical effect of recombinant tissue plasmodium activator arterial thrombolysis combined with intravascular therapy in treatment of cerebral infarction within 6 hours

目的探析重组组织型纤溶酶原激活剂(rt-PA)动脉溶栓联合血管内治疗发病时间6 h内急性脑梗死(ACI)的临床疗效。方法选取2017年2月—2019年3月徐州医科大学第二附属医院收治的发病<6 h ACI患者160例,按照患者及家属对治疗方案的选择意愿分组,观察组采取rt-PA+血管内支架成形术治疗,对照组采取rt-PA动脉溶栓,每组80例。比较两组术前、术后24 h、7 d、3个月NIHSS评分、ADL评分,观察患者血管再通情况,记录不良反应及临床预后。结果两组不同时间点的NIHSS评分和ADL评分有差异(P<0.05),两组的NIHSS评分和ADL评分有差异(P<0.05),两组的NIHSS评分和ADL评分变化趋势有差异(P<0.05)。观察组血管再通率为100%(完全再通76例,部分再通5例),对照组血管再通率为95%(完全再通62例,部分再通14例,未通4例),两组血管再通率比较差异有统计学意义(P<0.05)。观察组术后仅2例再发脑梗死,未出现死亡病例,对照组术后12例再发脑梗死,且4例因脑梗死伴脑疝死亡,两组预后比较差异有统计学意义(P<0.05)。结论ACI发病6 h内采取rt-PA联合血管内支架成形术治疗可提高溶栓效果,促进神经功能恢复,改善预后,安全性良好。但受血管内介入治疗技术及术前准备耗时等因素的影响,可能会延长溶栓处理时间,抵消早期动脉溶栓的优势,建议视患者病情制订个体化溶栓治疗方案。

Objective To investigate the clinical efficacy of recombinant tissue plasminogen activator(r-TPA)arterial thrombolysis combined with intravascular therapy in the treatment of cerebral infarction within 6 hours.Methods The data of 160 patients with acute cerebral infarction(ACI)admitted to our hospital from February 2017 to March 2019 were collected.According to the patient's family treatment plan,80 patients in the observation group were treated with r-TPA+vascular intervention(intravascular treatment with stenting),80 patients in the control group only received r-TPA arterial thrombolysis.NIHSS scores and ADL scores were compared before treatment,24 h,7 d,and 3 months after treatment.The recanalization of patients was observed,and adverse reactions and clinical prognosis were recorded.Results The NIHSS score and ADL score of the two groups were different at different time points(P<0.05),the NIHSS score and ADL score of the two groups were different(P<0.05),and the trend of the NIHSS score of the two groups was different(P<0.05).There was a difference in the trend of ADL score between the two groups(P<0.05).The revascularization rate in the observation group was 100%(76 cases of complete recanalization and 5 cases of partial recanalization),and the rate of vascular recanalization in the control group was 95%(62 cases of complete recanalization,14 cases of partial recanalization,and 4 cases of nonrecanalization).The difference in revascularization rate between the two groups was statistically significant(P<0.05).Only 2 cases of cerebral infarction recurred in the observation group after treatment,and no death occurred.12 cases of recurrent cerebral infarction in the control group after treatment,and 4 cases died due to cerebral infarction with cerebral hernia,the difference in prognostic data between the two groups is statistically significant(P<0.05).Conclusion The combination of r-TPA and endovascular treatment can improve the thrombolytic effect,promote the recovery of neurological function,improve the prognosis and have good safety.However,due to factors such as DSA technology and time-consuming preparation before vascular intervention,it may prolong the timing of thrombolytic treatment and offset the advantages of early arterial thrombolysis.It is recommended to develop an individualized thrombolytic therapy according to the patient's condition.