摘要
目的探讨不同溶栓治疗方法对急性大脑中动脉闭塞所致急性脑梗死的疗效及安全性。方法132例大脑中动脉闭塞急性脑梗死患者按就诊顺序采用抽签的方法随机分成3组，分别为静脉溶栓组（48例）、颈内动脉溶栓组（43例）及局部血栓内接触性溶栓组（41例），3组患者均给予阿替普酶治疗。对3组患者治疗前后神经功能缺失情况、疗效、并发症及病死率进行记录并进行统计学分析，符合正态分布的计量资料组间比较采用方差分析，计数资料比较采用χ^2检验，以P〈0．05为差异具有统计学意义。结果静脉溶栓组治疗后2、24h及2周有效率分别为18．8％（9／48）、39．6％（19／48）、45．8％（22／48），颈内动脉溶栓组治疗后2、24h及2周有效率分别为39．5％（17／43）、53．5％（23／43）、58．1％（25／43），血栓内接触性溶栓组治疗后2、24h及2周有效率分别为78．0％（32／41）、85．4％（35／41）、87．8％（36／41），血栓内接触性溶栓组2、24h及2周有效率明显高于颈内动脉溶栓组（X2值分别为12．809、9．979、9．289，P值均〈0．01）与静脉溶栓组（χ^2值分别为31．295、19．425、17．161，P值均〈0．01），差异具有统计学意义。颈内动脉溶栓组治疗后2h有效率高于静脉溶栓组，差异具有统计学意义（χ^2=4．801，P〈0．05），24h,2周有效率与静脉溶栓组差异无统计学意义（χ^2值分别为1．765、1．375，P值均〉0．05）。静脉溶栓组、颈内动脉溶栓组、血栓内接触性溶栓组术后2周出血率分别为14．6％（7／48）、14．0％（6／43）、7．3％（3／41），病死率分别为6．2％（3／48）、4．6％（2／43）、2．4％（1／41），各组间差异均无统计学意义（χ^2值分别为1．328、0．786，P值均〉0．05）。结论血栓内接触性溶栓治疗急性大脑中动脉闭塞性脑梗死起效快，效果好，值得推广。
Objective To evaluate the effect and safety of different thrombolytic therapies for acute cerebral infarction due to occlusion of middle cerebral artery（MCA） . Methods One hundred and thirty-two cases of acute cerebral infarction in territory of MCA were randomly divided into 3 groups, all of which were treated with alteplase. Group A （48 cases） was treated by intra-venous therapy with alteplase, group B （43 cases） was treated by infusing aheplase at the site of the internal carotid artery, and group C（41 cases） was treated by infusing alteplase into the thrombus. The improvement of neurological function, complications and mortality rate were recorded and statistically compared, with analysis of variance for counting data of normal distribution, χ^2 test for quantitative data, and the mean difference was significant at the 0. 05 level. Results The effective rates of group A,B and C at 2 h, 24 h, 2 w were 18.8% （9/48） ,39. 6% （19/ 48） ,45.8% （22/48）;39.5% （17/43）,53.5% （23/43）,58.1% （25/43）;78.0% （32/41）, 85.4% （35/ 41 ）,87.8% （36/41）respectively. The effective rate of group C was obviously better than group A （χ^2 = 12. 809,9. 979,9. 289, P 〈 0. 01 ） and B （ χ^2 = 31. 295, 19. 425, 17. 161, P 〈 0.01 ） with statistical significance. The effective rate of group B was better than group A at 2 h after thrombolytic therapy with statistical significance （χ^2 =4. 801 ,P 〈0.05）. The effective rate of group A and B did not have significant difference at 24 h, 2 w after therapy（χ^2 = 1. 765,1. 375,P 〉0. 05）. The hemorrhage rates of group A,B and C were 14. 6% （7/48）, 14.0% （6/43）,7.3% （3/41）, the mortality rates of group A, B and C were6. 2% （3/48） , 4. 6% （ 2/43 ） , 2.4% （ 1/41 ） , and there was no significant difference among the 3 groups （ χ^2 = 1. 328,0. 786, P 〉 0. 05 ）. Conclusion It is suggested that the thrombus-imbeded thrombolytic therapy is a better way in treating acute cerebral infraction due to occlusion of MCA for its rapid and better therapeutic effect.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2012年第7期636-639,共4页
Chinese Journal of Radiology
关键词
梗塞
大脑中动脉
放射学
介人性
对比研究
Infarction,middle cerebral artery
Radiology,interventional
Comparative study
