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目的对比分析机械取栓与动脉溶栓血管再通方法对于治疗急性脑动脉闭塞的有效性及安全性。方法回顾比较分析2005年5月至2014年5月期间行动脉溶栓及机械取栓患者,比较其发病到入院时间、入院到穿刺时间以及穿刺到获得再通时间、血管再通率TICI评分、患者术前及出院时NIHSS评分变化、90d时MRS评分、颅内出血发生率、死亡率。结果机械取栓组102例,动脉溶栓组50例,两组在发病入院时间(300 min vs.120 min,Z=-5.704,P=0.000),穿刺到再通时间(30 min vs.65 min,Z=-5.011,P=0.001)存在统计学差异,机械取栓组明显优于动脉溶栓组。两组在血管再通率(91.2%vs.60.0%,P=0.01)、总出血率(21.7%vs.36.0%,P=0.046)、死亡率(16.6%vs.26.0%,P=0.043)比较存在统计学差异,机械取栓组明显优于动脉溶栓组。两组90d时症状性出血率(12%vs.16%,P=0.055)、NIHSS评分变化(3 vs.4,Z=-0.236,P=0.823)、90d时良好预后率(48.2%vs.46.0%,P=0.823)比较无统计学差异。机械取栓组的支架放置率高于动脉溶栓组(22.5%vs.8.0%,P=0.018)。两组责任血管分层比较:机械取栓组颈内动脉(81.8%vs.55.6%,P=0.048)、基底动脉(93.1%vs.55.6%,P=0.032)、大脑中动脉(97.5%vs.60%,P=0.026)的血管再通率明显高于动脉溶栓组,机械取栓组颈内动脉(13.8%vs.33.3%,P=0.001)、基底动脉(13.8%vs.22.2%,P=0.011)的症状性出血率明显低于动脉溶栓组。机械取栓组大脑中动脉死亡率显著低于动脉溶栓组(2.5%vs.20.0%,P=0.000)。机械取栓组基底动脉良好预后率明显高于动脉溶栓组(41.3%vs.22.2%,P﹤0.01)。结论对于急性脑动脉闭塞患者的血管内治疗,机械取栓相比动脉溶栓有更宽的时间窗,更高的再通率和更好的预后。
Objective To compare the effectiveness and safety of mechanical thrombectomy and arterial thrombolysis recanalization in the treatment of acute cerebral artery occlusion. Methods A retrospective analysis of comparative analysis of patients with arterial thrombolysis and mechanical thrombectomy between May 2005 and May 2014 was performed to compare the time from admission to admission to admission to the time of puncture and to the time of reoperation and the TICI score of recanalization. The changes of NIHSS score at preoperative and discharge, MRS score at 90 days, the incidence of intracranial hemorrhage and mortality. Results There were 102 cases in mechanical thrombectomy group and 50 cases in arterial thrombolysis group. The time from admission to admission (300 min vs. 120 min, Z = -5.704, P = 0.000) min, Z = -5.011, P = 0.001), there was a significant difference between the mechanical thrombolysis group and the arterial thrombolysis group. The overall rate of bleeding (21.7% vs.36.0%, P = 0.046), mortality (16.6% vs.26.0%, P = 0.043) Compared with the statistic difference, mechanical thrombectomy group was superior to arterial thrombolysis group. The rates of symptomatic hemorrhage at 90 days (12% vs. 16%, P = 0.055), NIHSS scores (3 vs.4, Z = -0.236, P = 0.823) 46.0%, P = 0.823) no statistical difference. Stent placement was higher in the mechanical thrombectomy group than in the arterial thrombolysis group (22.5% vs. 8.0%, P = 0.018). Vascular stratification in the two groups was compared: the internal carotid artery in mechanical embolization group (81.8% vs.55.6%, P = 0.048), basilar artery (93.1% vs.55.6%, P = 0.032), middle cerebral artery (97.5% vs .60%, P = 0.026) were significantly higher than those in the thrombolytic group, the internal carotid artery in the mechanical thrombectomy group (13.8% vs.33.3%, P = 0.001), the basilar artery (13.8% vs.22.2% , P = 0.011) was significantly lower than the arterial thrombolysis group. In the mechanical thrombectomy group, the mortality rate of middle cerebral artery was significantly lower than that of the arterial thrombolysis group (2.5% vs.20.0%, P = 0.000). The good prognosis rate of basilar artery in mechanical thrombectomy group was significantly higher than that in arterial thrombolysis group (41.3% vs.22.2%, P <0.01). Conclusions For endovascular treatment of patients with acute cerebral artery occlusion, mechanical thrombectomy has a wider time window, higher recanalization rate, and better prognosis than arterial thrombolysis.