急性期动脉溶栓治疗基底动脉闭塞的疗效探讨  

Clinical study of intra-arterial thrombolytic therapy towards basilar artery occlusion

作　　者：李慎茂[1] 陶华[1] 朱凤水[1] 赵慧玭[1] 许研杰[1] 

机构地区：[1]北京宣武医院神经介入中心,北京100036

出　　处：《当代医学》2009年第29期520-523,共4页Contemporary Medicine

摘　　要：目的探讨动脉溶栓治疗基底动脉闭塞的治疗效果及其影响因素。方法回顾性分析68例基底动脉闭塞经动脉溶栓治疗的连续病例的临床资料,患者年龄26.0～70.0岁,平均(53.2±9.8岁);其中男性46例、女性22例;动脉溶栓疗效评价参考格拉斯哥预后评分,1～3分为预后不良,4～5分为预后良好。先根据出院病历评价患者出院时的短期疗效(住院期间疗效),然后通过电话随访评价患者术后1年左右的长期疗效。采用卡方检验比较预后良好和预后不良患者性别、年龄、发病至溶栓时间及头晕、眼球震颤、昏迷等症状和双侧Babinski征、闭塞部位、血管再通、血管成形和成形种类等指标之间的差别,以P<0.05为差异有统计学意义。结果短期疗效评价时间(患者住院时间)为2～60d,平均(20±15)d,预后良好41例,预后不良27例(包括死亡6例);血管再通良好45例;双侧Babinski(+)38例。在预后良好和不良患者,双侧Babinski(+)、血管再通良好、昏迷患者例数差异有统计学意义(P均<0.05)。支架成形患者较球囊成形患者预后好,差异有统计学意义(P<0.05)。预后良好和不良患者的年龄、性别、发病至溶栓时间间隔差异无统计学意义。长期随访时间1年,失访12例,预后良好41例,预后不良15例(包括死亡6例)。结论动脉溶栓治疗能够有效改善基底动脉闭塞患者的预后,但是其疗效与静脉溶栓相比,孰优孰劣尚无确切结论。Objective To evaluate therapeutic effect and influential factors of intra-arterial thrombolytic therapy of basilar artery occlusion. Methods By means of retrospective analysis, we collect 68 continuous cases. Of the total, 46male cases, 22female cases, and age range from 26 to 70 years （53.2 ± 9.8） years. According to Glasgow outcome scale, prognosis mala with 1-3 point and eusemia with 4-5 point indicate, first evaluate shortterm outcome of time to discharge based on discharge data, and long-term outcome of about 1 year based on phone call following-up, then evaluate influential factors of the former by chi square test, including sex, age, time to thrombolysis, dizziness, nystagmus, coma, bilateral babinski syndrome, occlusive part, revascularization, angioplasty and its type, finally evalate the correlation of angioplastic type and revascularization by fisher,s exact test. Results As to 68 total cases, the duration of short-term outcome range from 2 to 60（t （20 ± 15） d, 41 cases ofeusemia, 27 cases of prognosis mala; 38 cases of bilateral babinski syndrome （±） indicate prognosis mala （P=0.001）, 22cases of coma indicate prognosis mala （P=0.001）, 45 cases of favourable revascularization indicate eusemia （P=0.001）, stenting indicate favourable eusemia（P=0.003）. The duration of long-term outcome is about 1 year, apart from 12cases of loss to follow-up, 41 cases of eusemia, 15cases of prognosis mala. Conclusion It is effective to perform intra-arterial thrombolytic therapy of basilar artery occlusion. However, compared with systemic thrombolytic therapy, it is unknown whose outcome is better so far.

关 键 词：溶栓治疗 基底动脉 临床研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]