尿激酶动脉溶栓与重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中的疗效比较

摘要

目的 评价选择性动脉溶栓治疗急性脑梗死的疗效和安全性.方法 回顾性分析发病6 h内的急性脑梗死患者43例的临床资料,其中动脉溶栓组31例,静脉溶栓组12例.动脉溶栓组患者在发病6 h内经DSA证实为颅内血管闭塞,并进行超选择性动脉溶栓治疗(尿激酶总量<75万U);静脉溶栓组患者于发病3 h内接受重组组织型纤溶酶原激活剂(rt-PA)的溶栓治疗(0.9 mg/kg).观察两组的血管再通情况,于治疗后14 d、90 d及6个月,随访两组患者的美国国立卫生研究院卒中量表(NIHSS)评分、Bathel指数等情况.结果 ①动脉溶栓后,21例(67.74%)患者的临床症状完全恢复正常或有明显好转,术后14 d的NIHSS评分(12±7)低于术前评分(15±4),差异有统计学性意义,P<0.01.②动脉溶栓后18例完全再通、7例部分再通,6例未通.动脉溶栓术后90 d疗效比较,完全再通组优于未通组;术后6个月疗效比较,完全再通组优于未通组,部分再通组优于未通组,差异均有统计学意义.③不同牛津郡社区卒中项目(OCSP)分型患者经动脉溶栓后,术后14 d的NIHSS评分均低于溶栓前的NIHSS评分,术后90 d的NIHSS评分均低于溶栓前的和溶栓后14 d的NIHSS评分,差异有统计学意义,P<0.05.④动脉溶栓组的脑出血发生率、溶栓后14 d和90 d的NIHSS评分与发病3 h内静脉溶栓组比较,差异无统计学意义,P>0.05.结论 时间窗内动脉溶栓治疗能够明显提高闭塞血管的再通率,改善患者急性期临床症状和远期预后.在发病6 h后动脉溶栓组的近期疗效和远期预后均与静脉溶栓组相当.%Objective To evaluate the efficacy and safety of selective intra-arterial thrombolysis in patients with acute cerebral infarction. Methods Forty-three patients with acute cerebral infarction within 6 hours from the onset of symptoms were retrospectively selected. They were divided into an intra-arterial thrombolysis group (n =31 ) and an intravenous thrombolysis group (n = 12). The patients in the intra-arterial thrombolysis group were confirmed as intracranial vascular occlusion with digital subtraction angiography (DSA) and were treated with super-selective arterial thrombolysis ( ＜ 750 000 U); the patients in the intravenous thrombolysis group received intravenous recombinant tissue plasminogen activator (rt-PA) (0. 9 nag/kg). The recanalization was observed in the intra-arterial thrombolysis group. The NIHSS score and Barthel Index (BI) were followed up in both groups at days 14, 90, and 6 months after treatment.Results ①The clinical symptom of 21 patients (67.74％) recovered completely or improved significantly after intra-arterial thrombolysis. The NIHSS score 12 ±7 at 14 days after the procedure was lower than 15 ± 4 before the procedure. The difference was statistically significant ( P ＜ 0. 01 ). ②Aftor intra-arterialthrombolysis, 18 patients achieved complete recanalizafion,7 achieved partial recanalization, and 6 did not achieved recanalization. The efficacy comparison at day 90 after intra-arterial thrombolysis, the condition of patients in the complete recanalization group was superior to the non-recanalization group. The difference was statistically significant. (③The patients with different OCSP classifications after intra-arterial thrombolysis, the NIHSS scores at dayl4 after procedure were lower than those before thrombolysis. The NIHSS scores at day 90 after procedure were lower than those at 14 days before and after thrombolysis. The difference was statistically significant ( P ＜ O. 05 ). ④There were no significant differences in the incidence of intracerebral hemorrhage after thrombolysis and the NIHSS scores at day 14 and 90 after thrombolysis between the intra-arterial thrombolysis group and the intravenous thrombolysis group ( P ＞ 0. 05 ).Conclusion Intra-arterial thrombolysis within the time window may significantly increase the recanalizatinn rate of the occluded veasels, and improve the clinical condition and long-term prognosis of the patients.The short-term efficacy and long-term prognosis in the intra-arterial thrombolysis group are almost the same with the intravenous thrombolysis group.