摘要
目的评估超早期脑梗死应用标准剂量rt-pA静脉溶栓联合动脉取栓(桥接治疗)的临床治疗效果及安全性。方法回顾性连续收集我院神经内科2015年1月至2020年8月收治的40例发病时间在4.5 h以内的超早期脑梗死患者,所有患者均行头颅C TA或MRA检查证实急性大血管闭塞,且排除脑出血后行标准剂量rt-pA(0.9 mg·kg^(-1))静脉溶栓,溶栓过程中患者神经功能进行性恶化或溶栓30 min后症状未见好转者,立即通知卒中介入团队行血管内治疗。对照组为年龄、性别、基线NIHSS评分、发病时间相近的43例rt-pA静脉溶栓患者。观察并比较两组患者治疗后24 h、7 d、30 d的NIHSS评分。发病后第10天行颅脑MRA或造影评估血管再通情况。结果桥接组患者24 h、7 d和30 d NIHSS评分分别为(13.01±2.53)分、(9.85±2.47)分和(6.56±2.61)分,均低于治疗前(16.12±3.67),且差异有统计学意义(P<0.05)。单纯静脉溶栓组患者24 h、7 d和30 d NIHSS评分分别为(14.96±2.85)分、(11.23±2.84)分和(8.25±2.62)分,均低于治疗前(17.43±3.82),差异具有统计学意义(P<0.05)。两组治疗后是否出现颅内出血的差异无统计学意义(P>0.05)。结论超早期脑梗死患者,对于符合静脉溶栓指征的患者,首先进行标准剂量rt-pA静脉溶栓,临床症状改善不明显的,立即采用动脉机械介入取栓,可明显改善患者神经功能缺失症状,并且有较高的安全性。
OBJECTIVE To evaluate the efficacy and safety of standard dose rt-pA intravenous thrombolysis combined with arterial thrombectomy(bridging therapy)in the treatment of ultra-early cerebral infarction.METHODS Forty patients with ultra-early cerebral infarction with onset time within 4.5 h admitted to the Department of Neurology of the our Hospital from January 2015 to August 2020 were retrospectively collected.All patients were confirmed to have acute large vessel occlusion by CTA or MRA,and underwent intravenous thrombolysis with standard dose of rt-pA(0.9 mg·kg^(-1))after excluding cerebral hemorrhage.If the patient's neurological function progressively deteriorated or the symptoms were not improved half an hour after thrombolysis,the stroke intervention team was immediately notified for endovascular treatment.The control group consisted of 43 patients with similar age,gender,baseline NIHSS score,and onset to treatment time.The NIHSS scores at 24 hours,7 days,and 30 days after treatment were assesed and compared between the two groups.MRA or DSA was performed on the 10 th day after onset to treatment.RESULTS The NIHSS scores at 24 hours,7 days and 30 days in the bridging group were(13.01±2.53),(9.85±2.47)and(6.56±2.61),respectively,which were lower than those pre-treatment(16.12±3.67),and the difference was statistically significant(P<0.05).The NIHSS scores at 24 hours,7 days and 30 days in the intravenous thrombolysis alone group were(14.96±2.85),(11.23±2.84)and(8.25±2.62),respectively,which were lower than(17.43±3.82)than pre-treatment,and the difference was statistically significant(P<0.05).There was no significant difference in whether intracranial hemorrhage occurred after treatment between the two groups(P>0.05).CONCLUSION For patients with ultra-early cerebral infarction,standard dose rt-pA intravenous thrombolysis should be performed first,and when the clinical symptoms are not significantly improved.Immediate arterial mechanical interventional thrombectomy can be performed which was proved safet
作者
叶端玲
陈琳
卢红腾
陈海挺
陈金龙
许文勇
YE Duan-ling;CHEN Lin;LU Hong-teng;CHEN Hai-ting;CHEN Jin-long;XU Wen-yong(Department of Neurology,Xiamen Third Hospital affiliated to Fujian Traditioal Chinese Medicine University,Xiamen 361100,China;Department of Neurosurgery,Xiamen Third Hospital affiliated to Fujian Traditioal Chinese Medicine University,Xiamen 361100,China)
出处
《海峡药学》
2022年第4期142-146,共5页
Strait Pharmaceutical Journal
关键词
超早期脑梗死
静脉溶栓
动脉取栓
Ultra-early cerebral infarction
Intravenous thrombolysis
Arterial embolization
