CAJ | 학술논문

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x2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(x2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(x2 =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(x2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(x2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.
목적 탐토불동용전치료방법대급성대뇌중동맥폐새소치급성뇌경사적료효급안전성.방법 132례대뇌중동맥폐새급성뇌경사환자안취진순서채용추첨적방법수궤분성3조,분별위정맥용전조(48례)、경내동맥용전조(43례)급국부혈전내접촉성용전조(41례),3조환자균급여아체보매치료.대3조환자치료전후신경공능결실정황、료효、병발증급병사솔진행기록병진행통계학분석,부합정태분포적계량자료조간비교채용방차분석,계수자료비교채용x2검험,이P＜0.05위차이구유통계학의의.결과 정맥용전조치료후2、24h급2주유효솔분별위18.8％ (9/48)、39.6％(19/48)、45.8％( 22/48),경내동맥용전조치료후2、24h급2주유효솔분별위39.5％( 17/43)、53.5％ (23/43)、58.1％ (25/43),혈전내접촉성용전조치료후2、24h급2주유효솔분별위78.0％(32/41)、85.4％ (35/41)、87.8％(36/41),혈전내접촉성용전조2、24h급2주유효솔명현고우경내동맥용전조(x2치분별위12.809、9.979、9.289,P치균＜0.01)여정맥용전조(x2치분별위31.295、19.425、17.161,P치균＜0.01),차이구유통계학의의.경내동맥용전조치료후2h유효솔고우정맥용전조,차이구유통계학의의(x2 =4.801,P＜0.05),24h、2주유효솔여정맥용전조차이무통계학의의(x2치분별위1.765、1.375,P치균＞0.05).정맥용전조、경내동맥용전조、혈전내접촉성용전조술후2주출혈솔분별위14.6％( 7/48)、14.0％( 6/43)、7.3％ (3/41),병사솔분별위6.2％( 3/48)、4.6％( 2/43)、2.4％( 1/41),각조간차이균무통계학의의(x2치분별위1.328、0.786,P치균＞0.05).결론 혈전내접촉성용전치료급성대뇌중동맥폐새성뇌경사기효쾌,효과호,치득추엄.
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 alteplase 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,x2 test for quantitative data,and the mean difference was significant at the 0.05level.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( x2 =12.809,9.979,9.289,P ＜ 0.01 ) and B (x2 =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 (x2 =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 ( x2 =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 were 6.2％ (3/48),4.6％ (2/43),2.4％ (1/41),and there was no significant difference among the 3 groups ( x2 =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.