不同溶栓方法治疗心源性脑栓塞的对比研究  

Thrombolytic treatment of cardiogenic cerebral embolism:comparison study between different thrombolytic methods

作　　者：李水仙[1,2] 郑维红[2] 庄晓荣[2] 林威[2] 陈星宇[2] 阳清伟[2] 潘速跃[1] 

机构地区：[1]南方医科大学南方医院神经内科,广州510515 [2]厦门大学附属中山医院神经内科

出　　处：《介入放射学杂志》2014年第10期843-847,共5页Journal of Interventional Radiology

摘　　要：目的了解不同溶栓方法治疗心源性脑栓塞患者的有效性、安全性。方法 66例心源性脑栓塞患者分为静脉溶栓组25例、单纯动脉溶栓组18例、机械辅助动脉溶栓组23例,评估不同溶栓方法治疗后血管再通率、NIHSS评分、GCS评分、Barthel指数(BI)优率、症状性颅内出血率及病死率。结果 3组患者治疗后的NIHSS评分、GCS评分均较治疗前明显提高(P<0.05),机械辅助动脉溶栓组血管再通率(18/23,78.3%)、BI优率(10/25,40%)均明显高于静脉溶栓组(P<0.05);单纯动脉溶栓组的症状性颅内出血率(1/18,5.6%)明显低于静脉溶栓组(8/25,32%);病因分析发现,瓣膜性心脏病、黏液瘤所致脑栓塞的血管再通率低,颅内出血率和病死率高。结论溶栓治疗可改善心源性脑栓塞的神经功能缺损,机械辅助动脉溶栓治疗效果较好。Objective To evaluate the effect and safety of intravenous （IV） thrombolysis, intra-arterial （IA） thrombolysis and mechanical adjuvant intra- arterial thrombolysis （IA ＋ MA） in treating cardiogenic cerebral embolism. Methods A total of 66 patients with cardiogenic cerebral embolism were randomly divided into IV group （n = 25）, IA group （n = 18）, IA ＋ MA group （n = 23）. The artery recanalization rate, NIHSS score, GCS score, BI excellent rate, symptomatic intracranial hemorrhage rate and mortality after different thrombolytic therapies were determined. The results were compared between each other among the three groups. Results In all three groups both the post-treatment NIHSS score and GCS score were significantly improved when compared with pre-treatment ones （P 〈 0.05）. In IA ＋ MA group the artery recanalization rate was 78.3%（18/23） and the BI excellent rate was 40%（10/25）, which were significantly higher than those in IV group （P 〈 0.05）. The symptomatic intracranial hemorrhage rate in IA group was 5.6%（1/18）, which was strikingly lower than that in IV group （32%, 8/25）. Analysis of the causes showed that the artery recanalization rate in patients with valvular heart disease or cardiac myxoma was rather lower, but the intracranial hemorrhage rate and mortality in these patients were much higher. Conclusion Thrombolytic therapy can improve neurological deficit in cardiogenic cerebral embolism, and the therapeutic effect of mechanical adjuvant intra- arterial thrombolysis is definitely better.

关 键 词：溶栓 治疗 心源性脑栓塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]