急性脑梗死动脉溶栓治疗的疗效相关因素探讨  

Therapeutic effect of arterial thrombolysis for acute cerebral infarction:analysis of related factors

作　　者：田洪[1] 郝磊[1] 宋川[1] 张玉波[1] 周虎传[1] 刘磊[1] 

机构地区：[1]重庆成都军区第三二四医院脑血管病中心,400020

出　　处：《介入放射学杂志》2014年第10期839-842,共4页Journal of Interventional Radiology

基　　金：重庆市自然科学基金项目(cstc2012jjA10155)

摘　　要：目的探讨急性脑梗死动脉溶栓治疗效果与残存正向血流的关系。方法回顾性分析2009年1月—2013年12月进行动脉溶栓治疗的40例急性前循环脑梗死患者的临床资料。按照残存正向血流分为A、B组,A组23例,有正向血流或(和)侧支循环,B组17例,无正向血流和侧支循环,比较两组患者溶栓后14 d NIHSS评分和出血性转化情况。结果 A组拥有残存正向血流或(和)侧支循环,21例(91.3%)完全或部分再通,发生非症状性出血性转化1例,溶栓前NIHSS评分12.69±3.88,溶栓后14 d NIHSS评分6.05±3.25;B组无残存正向血流和侧支循环,15例(88.2%)完全或部分再通,发生1例非症状性出血性转化,1例症状性出血性转化(溶栓后7 h发生大量脑出血死亡),溶栓前NIHSS评分13.51±4.19,溶栓后14 d NIHSS评分8.68±5.16,两组比较差异有统计学意义(P<0.05);A组治疗14 d后显效率为68.1%,有效率为86.3%,而B组的显效率为43.8%,有效率为56.3%,提示A组临床效果较B组好。结论急性脑梗死动脉溶栓的效果不仅与时间窗密切相关,还与残存正向血流有关;残存正向血流多的患者动脉溶栓后临床效果好,出血风险低。Objective To investigate the relationship between the residual forward blood flow and the therapeutic outcome in patients with acute cerebral infarction after arterial thrombolysis treatment. Methods During the period from January 2009 to December 2013 at authors’ hospital, a total of 40 patients with acute anterior circle cerebral infarction were treated with arterial thrombolysis. The clinical data were retrospectively analyzed. The patients were divided into group A （n=23） when residual forward blood flow and/or collateral circulation were presented, and group B （n=17） if no residual forward blood flow and/or collateral circulation were detected. The NIHSS scores and hemorrhagic transformation state were determined 14 days after the thrombolysis treatment, and the results were compared between the two groups. Results In group A, 21 cases （91.3%） showed complete or partial re- canalization of the infracted vessels, and asymptomatic hemorrhagic transformation was seen in one case. The pre-treatment NIHSS score was 12.69 ± 3.88 and the post-treatment NIHSS score was 6.05 ± 3.25. In group B, complete or partial re-canalization of the infracted vessels was seen in 15 cases （88.2%）, asymptomatic hemorrhagic transformation was found in one case and symptomatic hemorrhagic transformation occurred in one case, who died of massive cerebral hemorrhage seven hours after the thrombolysis treatment. The pre-treatment NIHSS score was 13.51 ± 4.19 and the post-treatment NIHSS score was 8.68 ± 5.16. The differences between the two groups were statistically significant （P 〈 0.05）. The obvious effect rate in group A and group B was 68.1% and 43.8% respectively, and the effective rate in group A and group B was 86.3% and 56.3% respectively, indicating that the clinical outcome of group A was much better than that of group B.＆amp;nbsp;Conclusion The therapeutic effect of arterial thrombolysis for acute cerebral infarction patients is not only closely related to the time window but also to the residual

关 键 词：脑梗死 动脉溶栓 时间窗 疗效 侧支循环 

分 类 号：R743.33[医药卫生—神经病学与精神病学]