血管內介入治療前循環急性腦梗死的預后分析

梁余航+唐龍沖+方海波

【摘要】 目的：探討單純靜脈溶栓、單純機械再通與靜脈溶栓聯合機械再通治療前循環急性腦梗死的臨床效果及安全性。方法：選擇急性前循環腦梗死患者94例，根據治療方式的不同分為靜脈溶栓組（n=41），機械再通組（n=28）與聯合溶栓組（n=25）；靜脈溶栓組采用單純靜脈溶栓治療，機械再通組采用單純機械再通治療，聯合溶栓組采用靜脈溶栓聯合機械再通治療。根據預后良好率、死亡率、血管再閉塞率及患者并發癥發生情況比較三種方式的實際臨床效果。結果：靜脈溶栓組患者溶栓14 d后NIHSS評分比溶栓治療前低，差異有統計學意義（P<0.05）；機械再通組與聯合溶栓組患者溶栓治療3 d后NIHSS評分比溶栓治療前低（P<0.05）。聯合溶栓組預后良好率最高（P<0.05）；機械再通組血管再閉塞率最低（P<0.05）。三組患者死亡率及并發癥發生率比較，差異均無統計學意義（P>0.05）。結論：靜脈溶栓對技術要求較低，機械再通起效較快，血管再閉塞率低，聯合治療起效快，預后良好率高。

【關鍵詞】 靜脈溶栓； 前循環； 腦梗死； 介入治療； 預后分析

Prognostic Analysis of Intravascular Interventional Therapy for Anterior Circulation of Acute Cerebral Infarction/LIANG Yu-hang，TANG Long-chong，FANG Hai-bo.//Medical Innovation of China，2017，14（11）：034-037

【Abstract】 Objective：To explore the clinical effect and safety of intravenous thrombolysis，mechanical thrombolysis and intravenous thrombolysis combined with mechanical thrombolysis in the treatment of anterior circulation acute cerebral infarction.Method：A total of 94 cases of acute anterior circulation cerebral infarction were selected and divided into intravenous thrombolysis group （n=41），mechanical recanalization group （n=28） and combined thrombolysis group （n=25） according to the different treatment methods.Intravenous thrombolysis group was treated by intravenous thrombolysis.Mechanical recanalization group was treated by mechanical recanalization.The combination of thrombolysis and mechanical recanalization was used incombined thrombolysis group.According to good prognosis，mortality，Vascular Re occlusion rate and the incidence of complications，the actual clinical effects of three groups were compared.Result：After thrombolysis，the scores of NIHSS were lower than those before thrombolytic therapy（P<0.05）.NIHSS scores of mechanical recanalization group and combined thrombolysis group after thrombolytic therapy for 3 days were lower than those of before thrombolysis（P<0.05）.The rate of prognosis of combined thrombolysis group was the highest（P<0.05）.The rate of vessel re-occlusion of mechanical recanalization group was the lowest（P<0.05）.There were no statistical significances in mortality and the complication rate of three groups （P>0.05）.Conclusion：Intravenous thrombolysis has lower technical requirement，mechanical thrombolysis has rapider onset and lower re-occlusion rate，combined therapy has rapider onset and good prognosis.

【Key words】 Intravenous thrombolysis； Anterior circulation； Cerebral infarction； Interventional therapy； Prognosis analysis

First-authors address：Central Peoples Hospital of Zhanjiang，Zhanjiang 524037，China