超早期选择动脉内溶栓与静脉内溶栓治疗急性脑梗死疗效比较  

Comparison of clinical efficacy and safety of ultra-early treatment of intra-arterial and intravenous thrombolysis in patients with acute cerebral infraction

作　　者：杨小梅 金泉伟 YANG Xiao-mei;JIN Quan-wei(Department of Neurology,Ankang Central Hospital,Ankang 725000,Shaanxi,CHINA)

机构地区：[1]安康市中心医院神经内科

出　　处：《海南医学》2019年第19期2452-2455,共4页Hainan Medical Journal

基　　金：陕西省科技厅资助项目(编号:2015SF223)

摘　　要：目的比较超早期选择动脉内溶栓与静脉内溶栓治疗急性脑梗死(ACI)患者的临床疗效和安全性。方法回顾性分析2017年12月至2018年12月安康市中心医院神经内科收治的92例ACI患者的临床资料,根据治疗方式不同分为静脉溶栓组(尿激酶)47例和动脉溶栓组(导管抽拉血栓联合尿激酶混合生理盐水)45例,比较两组患者溶栓前和溶栓后几个重要时间点的欧洲卒中表(ESS)评分、溶栓效果、凝血指标及安全性。结果动脉溶栓组患者溶栓后4 h、8 h、1 d、3 d时的ESS评分分别为(74.89±13.29)分、(76.66±13.45)分、(78.85±13.53)分、(80.91±13.69)分,均明显高于静脉溶栓组的(66.15±16.31)分、(69.08±20.23)分、(72.33±19.98)分、(75.78±19.99)分,差异均有统计学意义(P<0.05),但两组患者术后7 d、14 d、28 d时的ESS评分比较差异均无统计学意义(P>0.05);静脉溶栓组患者的治疗总有效率为89.36%,与动脉溶栓组的97.78%比较差异无统计学意义(P>0.05),但静脉溶栓组患者的治疗致残率为10.64%,明显高于动脉溶栓组的2.22%,差异有统计学意义(P<0.05);治疗前,两组患者的纤维蛋白质、凝血酶原和凝血酶比较差异均无统计学意义(P>0.05),治疗一周后,动脉溶栓组的凝血酶原和凝血酶时间分别为(15.61±2.91)s、(11.59±1.72)s,明显短于静脉溶栓组的(17.82±1.38)s及(12.79±0.76)s,差异均有统计学意义(P<0.05);动脉溶栓组患者中颅内出血3例,其中1例为症状性颅内出血,静脉溶栓组共有6例发生颅内出血,静脉溶栓组出血及死亡高于动脉溶栓组,静脉溶栓组非症状性颅内出血及其他部位出血率高于动脉溶栓组,差异有统计学意义(P<0.05)。结论动脉内溶栓与静脉内溶栓对ACI的治疗均有较高的有效率,安全性也较好,但动脉内溶栓可以明显降低对患者神经系统的损害,降低致残率。Objective To investigate the clinical efficacy and safety of intra-arterial thrombolysis and intravenous thrombolysis in patients with acute cerebral infarction(ACI).Methods The clinical data of 92 patients with ACI admitted to the Department of Neurology,Ankang Central Hospital from December 2017 to December 2018 were retrospectively analyzed.According to different treatment methods,the patients were divided into the intravenous thrombolytic group(n=47,urokinase)and arterial thrombolysis group(n=45,catheter thrombectomy combined with urokinase and saline).The European Stroke Scale(ESS)score,thrombolytic effect,coagulation index and safety were compared between the two groups at several important time points before and after thrombolysis.Results In the arterial thrombolysis group,the ESS scores at 4 h,8 h,1 d,and 3 d after thrombolysis were 74.89±13.29,76.66±13.45,78.85±13.53,and 80.91±13.69,respectively,which were significantly higher than corresponding 66.15±16.31,69.08±20.23,72.33±19.98,and 75.78±19.99 in the intravenous thrombolysis group(all P<0.05);however,there was no significant difference in ESS scores at 7 d,14 d,and 28 d after surgery(P>0.05).The total effective rate of patients in the intravenous thrombolytic group was 89.36%versus 97.78%of the arterial thrombolysis group(P>0.05);but the morbidity rate of the patients in the intravenous thrombolytic group was 10.64%,which was significantly higher than 2.22%in the arterial thrombolysis group(all P<0.05).Before treatment,there was no significant difference in fibrin,prothrombin and thrombin between the two groups(P>0.05).After one week of treatment,the prothrombin and thrombin times in the arterial thrombolysis group were respectively(15.61±2.91)s and(11.59±1.72)s,which were significantly shorter than corresponding(17.82±1.38)s and(12.79±0.76)s in the intravenous thrombolysis group(P<0.05).There were 3 cases of intracranial hemorrhage in the arterial thrombolysis group,including 1 case of symptomatic intracranial hemorrhage;there were 6 case

关 键 词：急性脑梗死 静脉溶栓 动脉溶栓 纤维蛋白质 凝血酶原 

分 类 号：R743.33[医药卫生—神经病学与精神病学]