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目的对比分析急性脑梗死(ACI)患者在6h内超选择性动脉内溶栓与静脉内溶栓的治疗效果和安全性。方法随机将72例ACI患者分为动脉溶栓组和静脉溶栓组,其中动脉溶栓组25例,静脉溶栓组47例,分别在溶栓前、溶栓之后不同时间点采用欧洲卒中量表(ESS)进行评分,同时3d后行头颅MRI+MRA检查了解颅内血管再通情况。结果两组在溶栓后4h的ESS评分差异有统计学意义(P<0.05),8h、24h、72h、1周、2周、1个月ESS评分比较差异无统计学意义(P>0.05);3d后复查头颅MRA血管再通率动脉组优于静脉组,且凝血酶和凝血酶原的时间动脉组明显比静脉组短,差异均有统计学意义(P<0.05或P<0.001)。动脉组患者出血并发症发生率和死亡率均低于静脉组,但差异无统计学意义(P>0.05)。结论不管患者接受动脉内还是静脉内溶栓,对ACI的治疗都是有效的。但超选择性动脉内溶栓凝血指标(凝血酶时间及凝血酶原时间)和血管再通率均优于静脉溶栓。
Objective To compare and analyze the therapeutic effect and safety of superselective arterial thrombolysis and intravenous thrombolysis in patients with acute cerebral infarction (ACI) within 6 hours. Methods 72 patients with ACI were randomly divided into arterial thrombolysis group and intravenous thrombolysis group, of which 25 were in the arterial thrombolysis group and 47 were in the intravenous thrombolysis group, respectively, before thrombolytic therapy, after thrombolysis at different time points using the European stroke (ESS) were scored, and at the same time, 3 days after the head MRI + MRA examination of intracranial vascular recanalization. Results There was significant difference in ESS score between the two groups at 4h after thrombolysis (P <0.05). There was no significant difference in ESS score between the two groups at 8h, 24h, 72h, 1 week, 2 weeks and 1 month (P> 0.05) After 3d, the recanalization rate of MRA was higher in the arterial group than in the vein group, and the time-dependent group of thrombin and prothrombin time was shorter than that of the vein group (P <0.05 or P <0.001). The incidence of bleeding complications and mortality in arterial group were lower than those in intravenous group, but the difference was not statistically significant (P> 0.05). CONCLUSIONS: Treatment of ACI is effective regardless of whether patients receive an IV or IV thrombolysis. However, hyper-selective intra-arterial thrombolysis (thrombin time and prothrombin time) and recanalization rate were superior to intravenous thrombolysis.