上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (3): 314-.doi: 10.3969/j.issn.1674-8115.2013.03.012

• 论著（临床研究） • 上一篇    下一篇

超选择性动脉接触性溶栓联合机械碎栓术治疗急性脑梗死的研究

宋 军1, 史万超2, 苏志国2, 马 晨1, 刘振林2, 卢俏丽1   

  1. 天津市第五中心医院 1.神经内科, 2.神经外科, 天津 300450
  • 出版日期:2013-03-28 发布日期:2013-03-29
  • 作者简介:宋 军（1971—）, 男, 主任医师, 学士； 电子信箱: songjun_2007@sina.com。
  • 基金资助:

    天津市滨海新区卫生局科技计划项目（2011BHKY012）

Superselective arterial thrombolysis combined with mechanical thrombectomy for treatment of acute cerebral infarction

SONG Jun1, SHI Wan-chao2, SU Zhi-guo2, MA Chen1, LIU Zhen-lin2, LU Qiao-li1   

  1. 1.Department of Neurology, 2.Department of Neurosurgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, China
  • Online:2013-03-28 Published:2013-03-29
  • Supported by:

    Science and Technology Project of Tianjin Binhai New Area Health Bureau, 2011BHKY012

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摘要：

目的 研究超选择性动脉接触性溶栓联合机械碎栓术治疗急性脑梗死的有效性和安全性。方法 对30例急性脑梗死患者实施超选择性动脉接触性溶栓联合机械碎栓术治疗。通过数字减影血管造影术（DSA）显示血管再通情况；于溶栓前以及溶栓后7 d和1、3个月时，采用NIHSS评分对患者神经功能缺损进行评估；于溶栓前和溶栓后即刻及1、3 d时，采用GCS评分对患者意识状况进行评估；于溶栓后1、3个月时，采用Barthel指数（BI）对患者生活活动能力进行评估。溶栓后行头颅CT检查了解患者症状性颅内出血的发生情况。结果 30例患者经超选择性动脉接触性溶栓联合机械碎栓术治疗，26例患者血管再通，血管再通率达86.7%。与溶栓前比较，溶栓后7 d和1、3个月的NIHSS评分明显降低，差异有统计学意义（P<0.05）。与溶栓前比较，溶栓后即刻及1、3 d的GCS评分明显升高，差异有统计学意义（P<0.05）。溶栓后1、3个月的BI优良率分别为76.7%和80.0%。溶栓后影像学检查显示症状性颅内出血的发生率为6.7%。结论 采用超选择性动脉接触性溶栓联合机械碎栓术治疗急性脑梗死，可提高血管再通率，改善患者预后，是一种较安全、有效的治疗方式。

关键词: 溶栓治疗, 机械碎栓, 脑梗死

Abstract:

Objective To investigate the efficacy and safety of superselective arterial thrombolysis combined with mechanical thrombectomy for the treatment of acute cerebral infarction. Methods Thirty patients with acute cerebral infarction were treated with superselective arterial thrombolysis combined with mechanical thrombectomy. The vascular recanalization was illustrated by digital subtraction angiography (DSA). The neurological deficits were assessed by NIHSS before thrombolysis and 7 d, 1 month and 3 months after thrombolysis. The state of consciousness was evaluated by GCS before thrombolysis, immediately after thrombolysis and 1 d and 3 d after thrombolysis. The state of life was examined by Barthel Index (BI) 1 month and 3 months after thrombolysis. The symptomatic intracranial hemorrhage after thrombolysis was investigated by brain CT scan. Results After treatment, 26 patients had vascular recanalization, and the rate of vascular recanalization was 86.7%. The scores of NIHSS 7 d, 1 month and 3 months after thrombolysis were significantly lower than that before thrombolysis (P<0.05). The GCS scores immediately after thrombolysis and 1 d and 3 d after thrombolysis were significantly higher than that before thrombolysis (P<0.05). The good rates of BI were 76.7% and 80.0% respectively 1 month and 3 months after thrombolysis. The imaging examination revealed that the prevalence of symptomatic intracranial hemorrhage rate was 6.7%. Conclusion Superselective arterial thrombolysis combined with mechanical thrombectomy in treatment of acute cerebral infarction can improve the rate of recanalization and prognosis of patients, which is a relatively safe and effective method.

Key words: thrombolytic therapy, mechanical thrombectomy, cerebral infarction