摘要
目的观察在急性缺血性脑卒中患者中应用动静脉联合血管再通治疗的疗效和安全性。方法对2011年11月至2014年12月收治的急性缺血性脑卒中[美国国立卫生研究院卒中量表(NIHSS)评分≥10分]83例患者进行回顾性分析。将单纯静脉溶栓治疗的62例患者归为溶栓组;将静脉溶栓后无好转再行动脉内支架取栓治疗的21例患者归为取栓组。对两组进行疗效和安全性比较:1治疗7 d时比较两组NIHSS及改良Rankin(m RS)评分;2比较治疗后24 h的出血转化率和治疗后7 d的病死率。结果溶栓组和取栓组基线特征除高血压病史外余均差异无统计学意义(P﹥0.05)。两组疗效比较,治疗后7 d,NIHSS评分和m RS评分均差异无统计学意义(P﹥0.05)。两组安全性比较,治疗后24 h头颅CT显示出血转化率差异无统计学意义(P﹥0.05),两组治疗后7 d的病死率差异无统计学意义(P﹥0.05)。结论动脉取栓治疗的安全性与静脉溶栓治疗比较差异无显著性,且疗效未见比静脉溶栓治疗更好,可能与取栓治疗时间存在延误有关。
Aim To observe the efficacy and safety of combination therapy of intravenous thrombolysis and endovascular thrombectomy in patients with acute ischemic stroke. Methods The patients [the scores of the National Institutes of Health Stroke Scale（NIHSS） was more than 10 point] with acute ischemic stroke from November 2011 to December 2014 in our department were retrospectively reviewed. Totally 83patients who received 0.9 mg of alteplase per kilogram of body weight within 4.5 hours（NIHSS ﹥10 points） after the onset of ischemic stroke, among them 21 patients underwent endovascular thrombectomy with the Solitaire AB stent retriever（EV3）. The NIHSS and the score of modified Rankin Scale（m RS） at day 7 after therapy were compared between the thrombectomy group and the pure thromblolysis group. Secondary outcomes analysis included the rate of intracranial hemorrhage and the mortality. Results There were no significant differences in baseline except the history of hypertension. No significant differences were found in the score of NIHSS and m RS. Meanwhile, no significant differences were found in the rates of death or symptomatic intracerebral hemorrhage. Conclusion Both of the safety and efficacy of endovascular thrombectomy, used as an adjuvant therapy for intravenous thrombolysis, endovascular thrombectomy did not show early efficiency and were not superior to that of intravenous thrombolysis alone. Our observation strongly suggested that the combined therapy of intravenous thrombolysis and endovascular thrombectomy is safe and feasible, however, both intravenous thrombolysis and endovascular thrombectomy should be given to the patients more quickly.
出处
《中国临床神经科学》
2015年第5期481-487,共7页
Chinese Journal of Clinical Neurosciences
基金
浦东新区卫生局卫生(计生)科技项目(编号:PW2013D-4)
上海市第九人民医院院级项目(编号:JS201401)
国家自然科学基金项目(编号:81271302)
上海市科委创新行动计划基础研究重点项目(编号:14JC1404300)
关键词
缺血性脑卒中
静脉溶栓
血管内取栓
疗效
安全性
ischemic stroke
intravenous thrombolysis
endovascular thrombectomy
efficacy
safety
