CAJ | 학술논문

目的：研究动脉溶栓联合机械辅助治疗前后循环大动脉急性闭塞性脑梗死患者的有效性和安全性。方法42例大动脉闭塞性脑梗死患者行动脉溶栓联合机械辅助治疗，分为前循环组（24例）、后循环组（18例），评估不同组别治疗前后的NIHSS评分(National Institute of Health stroke scale)、GCS评分( Glasgow coma score，GCS)及治疗后血管再通率、BI( Barthel Index)优率、症状性颅内出血率、死亡率。结果前循环组卒中病因分型以心源性栓塞为主（15/24，62.5%），后循环组以动脉粥样硬化性血栓形成为主（5/18，72.2%），两组间比较，差异有统计学差异（P=0.026）；前、后循环组患者，治疗后的NIHSS评分（8.3±4.9 vs.8.1±5.7）较治疗前（15.1±5.3 vs.16.8±7.8）明显降低（P=0.001 vs. P=0.001）、GCS评分（13.9±4.4 vs.12.8±4.2）较治疗前（9.5±3.8 vs.9.6±3.7）明显提高（P=0.001 vs. P=0.021），后循环血管再通率（15/18，83.3%）有高于前循环（14/24,58.3%）趋势（P=0.830），前循环组患者颅内出血发生率(5/24，20.8%)明显高于后循环组（0，0%）（P=0.039），两组患者死亡率相似。结论动脉溶栓联合机械辅助治疗脑梗死能改善神经功能缺损，血管再通率高，更适用于后循环脑梗死的治疗。
목적：연구동맥용전연합궤계보조치료전후순배대동맥급성폐새성뇌경사환자적유효성화안전성。방법42례대동맥폐새성뇌경사환자행동맥용전연합궤계보조치료，분위전순배조（24례）、후순배조（18례），평고불동조별치료전후적NIHSS평분(National Institute of Health stroke scale)、GCS평분( Glasgow coma score，GCS)급치료후혈관재통솔、BI( Barthel Index)우솔、증상성로내출혈솔、사망솔。결과전순배조졸중병인분형이심원성전새위주（15/24，62.5%），후순배조이동맥죽양경화성혈전형성위주（5/18，72.2%），량조간비교，차이유통계학차이（P=0.026）；전、후순배조환자，치료후적NIHSS평분（8.3±4.9 vs.8.1±5.7）교치료전（15.1±5.3 vs.16.8±7.8）명현강저（P=0.001 vs. P=0.001）、GCS평분（13.9±4.4 vs.12.8±4.2）교치료전（9.5±3.8 vs.9.6±3.7）명현제고（P=0.001 vs. P=0.021），후순배혈관재통솔（15/18，83.3%）유고우전순배（14/24,58.3%）추세（P=0.830），전순배조환자로내출혈발생솔(5/24，20.8%)명현고우후순배조（0，0%）（P=0.039），량조환자사망솔상사。결론동맥용전연합궤계보조치료뇌경사능개선신경공능결손，혈관재통솔고，경괄용우후순배뇌경사적치료。
Objective To study the effect and safety of intra-arterial thrombolysis combined with mechanical ad-juvant in the treatment of acute large artery occlusive infarction of anterior circulation and posterior circulation. Methods Fourty-tow patients were divided into anterior circulation group (24 cases) and posterior circulation group(18 cases). The recanalization rate, NIHSS score (National Institute of Health stroke scale), GCS score ( Glasgow coma score,GCS), BI ( Barthel Index) excellent rate, symptomatic intracranial hemorrhage rate and mortality was analyzed after intra-arterial thrombolysis combined with mechanical aids therapy. Results The anterior circulation group was mainly caused by car-diogenic embolism (15/24, 62.5%) and posterior circulation group was mainly caused by atherosclerosis thrombosis (5/18, 72.2%). The NIHSS score was significantly lower after treatment (8.3±4.9 vs. 8.1±5.7) than before treatment(15.1±5.3 vs. 16.8±7.8)(P=0.001 vs. P=0.001), the GCS score was significantly higher after treatment(13.9±4.4 vs. 12.8±4.2)than be-fore treatment(9.5 ± 3.8 vs. 9.6 ± 3.7)(P=0.001 vs. P=0.021). The symptomatic intracranial hemorrhage rate was signifi-cant higher in anterior circulation group (5/24, 20.8%) than in posterior circulation group (0,0%) (P<0.05). Compared with the anterior circulation group, the recanalization rate trended to increase in posterior circulation group (P=0.830).The symptomatic intracranial hemorrhage rate in anterior circulation group (5/24,20.8%) was significant higher than in pos-terior circulation group (0,0%) (P<0.05), the mortality was similar between these two groups. Conclusions Intra-arterial thrombolysis combined with mechanical adjuvant therapy can improve neurological deficit in acute large artery occlusive infarction and increase the recanalization rate,which is more suitable for the treatment of posterior circulation infarction.