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    静脉溶栓联合介入取栓对急性脑梗死病人预后改善的有效性分析

    Effectiveness analysis of intravenous thrombolysis combined with interventional thrombectomy in improving the prognosis of patients with acute cerebral infarction

      摘要
    • 摘要:
      目的研究急性脑梗死病人静脉溶栓联合介入取栓术是否能够有效改善病人预后。
      方法选取33例急性脑梗死病人，依据治疗方式的不同分为静脉溶栓组（A组，17例）、静脉溶栓联合介入治疗组（B组，16例）。收集所有病人治疗前后的相关临床资料，主要包括：性别、年龄、吸烟史、血压、血糖水平、总胆固醇水平、溶栓治疗等待时间等，分析急性脑梗死相关危险因素及病人治疗前后的美国国立卫生研究院卒中量表（NIHSS）评分和Barthel指数评分变化，比较病人的预后及生活能力差异。
      结果病人的血压水平、血糖水平、总胆固醇水平、血浆D-二聚体水平、纤维蛋白原降解产物以及吸烟史与急性脑梗死病人入院后的NIHSS评分均呈正相关关系（P < 0.05~P < 0.01）。急性脑梗死病人的治疗效果及预后与接受治疗的等待时间和治疗方法有密切关系，A组病人治疗后7 d和B组病人治疗后24 h、7 d后的NIHSS评分变化均与等待治疗时间长短有关，等待治疗时间越短，NIHSS评分改善越明显（P < 0.05~P < 0.01）。同时，溶栓等待时间越短，病人的Barthel评分改善越明显（P < 0.01）。治疗后24 h及7 d，B组病人NIHSS评分和Barthel评分改善相对A组均改善更加明显（P < 0.01）。
      结论急性脑梗死病人从发病到接受溶栓治疗的时间越短越有助于病人的恢复，静脉溶栓联合介入取栓治疗对急性脑梗病人的恢复效果优于单纯静脉溶栓治疗。

       

      Abstract:
      ObjectiveTo study whether intravenous thrombolysis combined with interventional thrombectomy can effectively improve the prognosis of patients with acute cerebral infarction.
      MethodsThirty-three patients with acute cerebral infarction were selected and randomly divided into intravenous thrombolysis group (group A, 17 cases) and intravenous thrombolysis combined with interventional thrombectomy group (group B, 16 cases) according to different treatment methods.Relevant clinical data of all patients before and after treatment, including gender, age, smoking history, blood pressure, blood sugar level, total cholesterol level, waiting time for thrombolytic therapy and so on were collected.The risk factors of acute cerebral infarction and the changes of the National Institutes of Health stroke scale (NIHSS) score and Barthel index score between before and after treatment were analyzed, and the prognosis and living ability of patients were compared.
      ResultsThe levels of blood pressure, blood glucose, total cholesterol, plasma D dimer, fibrinogen degradation products and smoking history were positively correlated with the NIHSS score after admission to the hospital (P < 0.05 to P < 0.01).Pearson correlation analysis found that the patient's blood pressure and blood glucose level were the key factors affecting the occurrence of acute cerebral infarction(r=0.768, 0.559).The treatment effect and prognosis of patients with acute cerebral infarction were closely related to the waiting time and treatment methods for treatment.The changes of NIHSS score of patients in group A at 7 days after treatment, and at 24 hours after treatment and 7 days after treatment in group B were tightly related to the length of waiting time for treatment, i.e.the improvement of NIHSS score was more obvious with shorter waiting time for treatment (P < 0.05).There was no significant correlation between the changes of NIHSS score of patients in group A and the waiting time for treatment at 24 h after treatment (P>0.05), while which in group B had different degrees of improvement.At the same time, the improvement of the patient's Barthel score was more obvious with shorter the waiting time for thrombolysis (P < 0.01).At 24 h and 7 d after receiving treatment, the improvement of NIHSS score and Barthel score of patients in group B was more obvious than that in group A(P < 0.01).
      ConclusionsThe better the recovery of patients with acute cerebral infarction can be obtained with shorter time from onset to thrombectomy.Intravenous thrombolysis combined with interventional thrombectomy has better recovery effect for patients with acute cerebral infarction than intravenous thrombectomy alone.

       

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