【摘要】 目的 评价动脉溶栓联合血管内支架成型术治疗急性颈内动脉系统脑梗死的疗效与安全性。方法 22例动脉溶栓后遗有血管狭窄的急性脑梗死患者,男性10例,女12例,平均年龄(66.18±11.49)岁,均在发病6 h内接受治疗。分为治疗组10例和对照组12例,分别给予支架治疗和常规药物治疗,于术后第1天和30天比较两组NIHSS评分及病死率。结果 与对照组相比,治疗组患者临床症状明显改善,术后1 d和30 d的NIHSS评分都显著降低(P<0.05)。治疗组无1例死亡。结论 动脉溶栓联合血管内支架成型术治疗急性脑梗死较单纯动脉溶栓疗效好,而且较为安全。 【关键词】 急性脑梗死 ; 动脉溶栓 ;血管内支架成形术 Abstract : Objective To evaluate the safety and efficacy of intraarterial thrombolytic therapy in combination with percutaneous transluminal angioplasty (PTA)on acute cerebral infarction of internal carotid artery system. Methods 22 patients with acute cerebral infarction (10 male and 12 female) were divided into two groups, who were treated with intraarterial thrombolysis therapy within 6 hours after symptom onset and remained angiostegnosis with the mean age of 66.18±11.49?years?old.The patients in the therapeutic group (10 cases) were treated with percutaneous transluminal angioplasty, while the patients in the control group (12 cases) were treated with conventional medicine.The death rate and NIHSS (National Institutes of Health Stroke Scale) scores were evaluated on the 1st day as well as 30th day after PTA.Results Combined therapy improved the symptoms of the patients with acute ischemic stroke and significantly lowered the scores of NIHSS on the 1st day and 30th day after PTA (P<0.05).There were no died case in treated group.Conclusion The combined therapy of acute cerebral infarction with intraarterial thrombolytic and percutaneous transluminal angioplasty is more effective and safer than that treated with intraarterial thrombolytic therapy only. 急性脑梗死治疗关键是使闭塞血管再通,溶栓疗法被认为是其根本性治疗方法之一。动脉溶栓能够提高血管再通率,但部分患者遗留有血管狭窄,溶栓治疗无法使血管完全再通。近年来研究者在不断探索溶栓治疗的同时行血管内成形术或放置血管内支架等,以提高再通率,进一步提高疗效。我科应用动脉溶栓联合血管内支架成形术治疗急性脑梗死,探讨其疗效及安全性。 1.1 一般资料 1.1.1 分组 将22例遗有明显血管狭窄者随机分2组,治疗组:同时予以支架治疗(10例);对照组:予以常规药物治疗(12例)。男性10例,女性12例。年龄45~79岁,平均(66.18±11.49)岁。两组间年龄[治疗组(70.8±5.6)岁,对照组(65.2±12.3)岁]、溶栓药量[治疗组(35.0±17.32)万u,对照组(34.0±21.5)万u]差异无显著性。两组间血管狭窄程度治疗组(82.98±8.8)%,对照组(80.86±9.01)%,差异无显著性。狭窄率测量方法:狭窄率(%)=(1-病变部位最狭窄直径/估算的正常血管直径)×100%。 1.1.2 血管支架成形术的标准 ①溶栓后遗留狭窄超过70%;②溶栓未再通;③症状无改善或再闭塞;④家属同意。禁忌证:①狭窄部位伴有软血栓。②合并Ehlers-Danlos综合征(一种罕见的遗传性结缔组织病,特征为血管脆弱伴出血倾向)。③严重血管迂曲。④凝血障碍或造影剂过敏。⑤合并严重的全身器质性疾病如心、肝、肾功能障碍。⑥双侧颈动脉闭塞或双侧椎动脉闭塞。⑦CT或MRI显示严重的梗死灶。⑧3周之内有严重的卒中发作。⑨严重的神经功能障碍。 1.2 临床表现 1.3 疗效评定 采用NIHSS评分(美国国立卫生研究院卒中量表),于治疗前、治疗后1d、30 d分别行NIHSS评分。根据文献标准评定预后[2]:①基本痊愈:功能缺损评分减少91%~100%,病残程度为0;②显著进步:功能缺损评分减少18%~90%,病残程度为1~3级;③无效:功能缺损评分减少或增加在17%以内。 1.4 治疗方法 |