支架取栓加尿激酶动脉溶栓治疗急性脑梗死的临床疗效观察  

Curative effect observation of stent-thrombectomy combined with arterial urokinase thrombolysis in treating patients with acute cerebral infarction

作　　者：符俊骐[1] 夏鹰[1] 史克珊[1] 林佳[1] 

机构地区：[1]海口市人民医院神经外科,570208

出　　处：《中华神经医学杂志》2014年第2期156-159,共4页Chinese Journal of Neuromedicine

基　　金：海南省卫生厅重点医学科研立项课题（琼卫20lO重点一07）

摘　　要：目的探讨支架取栓加尿激酶动脉溶栓与单纯尿激酶动脉溶栓治疗急性脑梗死的临床疗效差异。方法选取海口市人民医院神经外科2011年问进行单纯尿激酶动脉溶栓治疗的28例急性脑梗死患者（尿激酶组）和2012年间进行SolitaireAB支架取栓加尿激酶动脉溶栓治疗的29例急性脑梗死患者（支架组）为研究对象，比较2组患者术后神经功能障碍评分、血管再通率、颅内出血率等。结果支架组20例大脑中动脉闭塞再通，3例颈内动脉闭塞再通，4例椎基底动脉闭塞再通，再通率为93．1％：术后均无颅内出血发生，2例颈内动脉闭塞患者死亡。尿激酶组15例大脑中动脉闭塞再通，3例颈内动脉闭塞再通，2例椎基底动脉闭塞未通．再通率为64．2％：术后颅内出咀5例，死亡8例（颈内动脉闭塞患者6例，椎基底动脉闭塞患者2例、。支架组患者术后14d较术前美国国立卫生研究院卒中量表（NmSS）评分差值与尿激酶组比较（13．37±4．26 t/S 11．40±4．57）差异有统计学意义（氏0．05）。随访3个月，支架组预后良好（nags评分〈2）20例，尿激酶组17例。结论支架取栓加尿激酶动脉溶栓治疗急性脑梗死的临床疗效优于单纯尿激酶动脉溶栓治疗。Objective To compare the therapeutic differences between stent-thrombectomy combined with urokinase thrombolysis and simple arterial urokinase thrombolysis in treating patients with acute cerebral infarction. Methods Arterial urokinase thrombolysis was carried out in 28 selected patients with acute cerebral infarction, admitted to our hospital in 2011 （urokinase group）, while Solitaire AB stent-thrombectomy combined with arterial urokinase thrombolysis was carried out in 29 patients with acute cerebral infarction, admitted to our hospital in 2012 （combination group）. Postoperative indices, including National Institutes of Health Stroke Scale （NIHSS）, recanalization rate and intracranial hemorrhage incidence, were analyzed between the two groups. Results Recanaliztion rate of combination group was detailed as： middle cerebral artery in 20 patients, internal carotid artery in 3 patients, and vertebral-basilar artery in 4 patients, with a total recanalization rate of 93.1%. No postoperative hemorrhage was confirmed; two patients diagnosed as having internal carotid artery occlusion died. Recanaliztion rate of urokinase group was detailed as： middle cerebral artery in 15 patients, internal carotid artery in 3 patients, and vertebral-basilar artery in 0 patients, with a total recanalization rate of 64.2%; postopertive intracranial hemorrhage was noted in 5 patients and death in 8. For combination group, postoperative fourteen-day NIHSS scores decreased by 11.40＋4.57 as compared with preoperative NIHSS scores; for urokinase group, postoperative fourteen-day NIHSS scores decreased by 11.40_＋4.57 as compared with preoperative NIHSS scores; significant differece was noted between the two groups （P〈0.05）. Postoperative satisfactory rehabilitation （modified Rankin scale scores〈2） in combination group and urokinase group appeared in 20 and 17 patients, respectively, after 3 months offollow up. Conclusion The efficacy of stent-thrombectomy combined with arterial urokinase thrombolysis is superi

关 键 词：急性脑梗死 动脉溶栓 支架取栓 尿激酶 

分 类 号：R743.34[医药卫生—神经病学与精神病学]