尿激酶静脉溶栓与超选择性动脉溶栓治疗急性大脑中动脉脑梗死的疗效及对FIB、PT和TT的影响

摘要

目的 对比研究尿激酶(UK)静脉溶栓(IVT)与超选择性动脉溶栓(SIAT)治疗急性大脑中动脉脑梗死(aMCAI)的疗效及对凝血指标纤维蛋白原(FIB)、凝血酶原时间(PT)和凝血酶时间(TT)的影响.方法 选取aMCAI患者82例,其中41例IVT治疗为IVT组,41例SIAT治疗为SIAT组.比较两组临床疗效、并发症情况,观察并比较两组溶栓前后美国国立卫生研究院卒中量表(NIHSS)评分及FIB、PT及TT变化.结果 SIAT组的临床治愈率和血管再通率分别75.61%、87.80%,显著高于IVT组的58.54%、68.29%(均P<0.05);溶栓后6h、24h、3d、7d,SIAT组的NIHSS评分显著低于IVT组(均P<0.05),溶栓后14d、28d两组NIHSS评分比较,差异无统计学意义(P>0.05).溶栓后6h、3d、7d,IVT组的PT和TT较SIAT组明显延长,且溶栓后6h、3d时FIB较SIAT组明显降低(均P<0.05).SIAT组的平均UK用量显著低于IVT组(P<0.05),SIAT组的出血并发症发生率为7.32%,显著低于IVT组的29.27%(均P<0.05).结论 IVT与SIAT治疗aMCAI均具有显著疗效,但SIAT对凝血指标的干扰更小,出血并发症更低,且神经功能缺损改善速度更快.%Objective To investigate the effect of intra-venously thrombolysis (IVT) and superselective intra-arterial thrombolysis (SIAT) with urokinase (UK) in the treatment of acute middle cerebral artery infarction (aMCAI) and the influence on coagulation indicators. Method A total of 82 patients with aMCAI were enrolled,in which there were 41 cases of IVT treatment (IVT group) and 41 cases of SIAT treatment (SIAT group). The clinical effect and complications were compared between the two groups, the NIHSS score and coagulation indicators (FIB, PT, TT) were evaluated. Results The cure rate and vascular recanalization ratewas 75.61%, 87.80% in SIAT group, significantly higher than 58.54%, 68.29% in the IVT group (P<0.05). After 2h,24h,3d,7d of thrombolysis, the NIHSS scores in SIAT group were significantly lower than those in IVT group (P<0.05), no statistically significant differences of NIHSS scores after 14d and 28d of thrombolysis between the two groups (P>0.05). The levels of PT and TT in IVT group was significantly longer than those in SIAF group after 6h,3d,7d of thrombolysis (P<0.05), and the levels of FIB were significantly lower than the SIAF group after 6h,3d of thrombolysis (P<0.05). The average dosage of UK in SIAT group was significantly lower than that in the IVT group(P<0.05). The rate of bleeding complications in SIAT group was significantly lower than that in the IVT group(7.32% vs 29.27%, P<0.05). Conclusion IVT and SIAT of UK has exact clinical effect in treating aMCAI,but the influence on coagulation indicators and bleeding complication of SIAT is less,and its working time of the of neurological deficits improvement is shorter.