静脉溶栓桥接机械取栓治疗房颤脑栓塞临床研究  

Clinical study on combined intravenous thrombolysis and mechanical thrombectomy for cerebral infarction patients with atrial fibrillation

作　　者：张肖 张保朝[2] 

机构地区：[1]新乡医学院研究生院,河南新乡453000 [2]南阳市中心医院,河南南阳473000

出　　处：《中国实用神经疾病杂志》2018年第3期261-265,共5页Chinese Journal of Practical Nervous Diseases

基　　金：北京医卫健康公益基金会医学科学研究基金资助项目(YWJKJJHKYJJ-B17781)

摘　　要：目的探讨静脉溶栓桥接机械取栓治疗房颤脑栓塞的有效性及安全性。方法回顾性分析2015-10—2017-09就诊于南阳市中心医院、发病4.5h内的43例房颤脑栓塞患者的临床资料,其中28例接受静脉溶栓桥接机械取栓,15例接受单纯机械取栓,比较2组入院到穿刺时间、穿刺到获得再通时间、血管再通率、入院时及出院时NIHSS评分变化,90d良好预后率、取栓次数、症状性颅内出血发生率、病死率。结果 2组入院到穿刺时间、血管再通率比较差异无统计学意义(P>0.05)。穿刺到再通时间、NIHSS评分变化、90d良好预后率、取栓次数比较差异有统计学意义(P<0.05)。症状性颅内出血率、病死率比较差异无统计学意义(P>0.05)。结论对于房颤脑栓塞患者,静脉溶栓桥接机械取栓与单纯机械取栓相比,两者症状性颅内出血率及病死率相近,但前者的血管再通时间更短,短期效果及90d预后优于后者。Objective To investigate the safety and effectiveness of combined Intravenous thrombolysis and mechanical thrombectomy（IVT and MT）in cerebral infarction patients with atrial fibrillation（AF）. Methods The clinical data of 43 patients with acute cerebral infarction and less than 4.5 h of symptom onset combined with AF from September 2015 to October 2017 in Nanyang Central Hospital were collected;of them, 28 cases received IVT and NIT, and 15 cases received MT alone. A retrospective analysis was conducted on the onset to emergency（OTE）time, emergency to acupuncture（ETA）time, acupuncture to recanalization （ATR） time, the recanalization rate, the change of the National Institutes of Health Stroke Scale （NIHSS）score, the better prognosis rate at 90 days,the number of passes with stent retriever, symptomatic intracranial hemorrhage（SICH）and mortality. Results There was no statistically difference in the OTE time, the ETA time. The SICH and mortality were also similar among groups. The difference was statistically significant in the ATR time, the change of NIHSS score, the better prognosis rate at 90 days and the number of passes. Conclusion For cerebral infarction patients with atrial fibrillation, thetreatment of IVT and MT is similar to that of MT alone in symptomatic intracranial hemorrhage and mortality, but the ATR time of the IVT and MT is shorter, the early efficacy and 90d favorable prognosis is better than that of MT alone.

关 键 词：房颤 脑栓塞 静脉溶栓桥接机械取栓 单纯机械取栓 阿替普酶 

分 类 号：R743.32[医药卫生—神经病学与精神病学]