CAJ | 학술논문

目的：观察动静脉联合溶栓与机械取栓治疗急性脑梗死患者的临床疗效及预后。方法选择2012年6月—2014年6月诊断为急性脑梗死颅内血管狭窄或闭塞患者70例为研究对象，根据溶栓方法不同分为动静脉联合溶栓组（对照组）35例，机械取栓组（观察组）35例。治疗前后分别对患者行美国国立卫生研究院卒中量表（NIH-SS）评分、临床有效性、近期疗效与远期预后观察。结果观察组临床疗效明显优于对照组（97？.14％vs.80.0％，χ2=5.081， P ＜0.05）。观察组治疗后3 d及14 d NIHSS评分较治疗前明显降低（ t =5.667，5.850， P ＜0.05）。对照组治疗后3 d与治疗前NIHSS评分比较，差异无统计学意义（ t =1.683， P ＞0.05），治疗后14 d NIHSS评分较治疗前明显降低（ t =8.326， P ＜0.05）；2组治疗后3 d比较差异有统计学意义（ t =3.767， P ＜0.05），治疗后观察组TIMI血流≥2级明显多于对照组，血管急性再闭塞率明显少于对照组（χ2=17.481、10.403， P ＜0.01）。治疗后2组病变残余狭窄率、24 h内症状性颅内出血发生率及3个月病死率比较差异无统计学意义（χ2=3.188、0.159、0.348， P ＞0.05）。结论机械取栓治疗急性脑梗死患者效果优于动静脉联合溶栓，对神经功能改善时间较早，且其远期临床预后较好。
목적：관찰동정맥연합용전여궤계취전치료급성뇌경사환자적림상료효급예후。방법선택2012년6월—2014년6월진단위급성뇌경사로내혈관협착혹폐새환자70례위연구대상，근거용전방법불동분위동정맥연합용전조（대조조）35례，궤계취전조（관찰조）35례。치료전후분별대환자행미국국립위생연구원졸중량표（NIH-SS）평분、림상유효성、근기료효여원기예후관찰。결과관찰조림상료효명현우우대조조（97？.14％vs.80.0％，χ2=5.081， P ＜0.05）。관찰조치료후3 d급14 d NIHSS평분교치료전명현강저（ t =5.667，5.850， P ＜0.05）。대조조치료후3 d여치료전NIHSS평분비교，차이무통계학의의（ t =1.683， P ＞0.05），치료후14 d NIHSS평분교치료전명현강저（ t =8.326， P ＜0.05）；2조치료후3 d비교차이유통계학의의（ t =3.767， P ＜0.05），치료후관찰조TIMI혈류≥2급명현다우대조조，혈관급성재폐새솔명현소우대조조（χ2=17.481、10.403， P ＜0.01）。치료후2조병변잔여협착솔、24 h내증상성로내출혈발생솔급3개월병사솔비교차이무통계학의의（χ2=3.188、0.159、0.348， P ＞0.05）。결론궤계취전치료급성뇌경사환자효과우우동정맥연합용전，대신경공능개선시간교조，차기원기림상예후교호。
Objective To observe the therapeutic effect and prognosis of intra-arterial combined with intravenous thrombolysis and mechanical thrombectomy for the treatment of acute cerebral infarction .Methods From 2012 June to 2014 June, 70 patients who were diagnosed of acute cerebral infarction and intracranial vascular stenosis or occlusion were enrolled , according to the different thrombolytic method , they were divided into intra-arterial combined with intravenous thrombolytic group with (control group) 35 cases, mechanical thrombectomy group with (observation group) 35 cases.Before and after the treatment, the National Institutes of Health Stroke Scale (NIHSS) score, clinical efficacy and prognosis in the short-term and long-term were evaluated in these patients .Results The clinical efficacy of observation group was better than the control group (97.14%vs.80.0%,χ2=5.081, P <0.05);in the observation group, after 3 d and 14 d's treatment, NIHSS score was significantly decreased than before treatment ( t =5.667, t =5.850, P <0.05);3 d after treatment, in the control group, compared with before treatment, NIHSS score's difference was not statistically significant ( t =1.683, P >0.05), af-ter 14 d's treatment, NIHSS score was significantly lower than that of before treatment ( t =8.326, P <0.05);3 d's after treatment, 2 groups'difference was statistically significant ( t =3.767, P <0.05), after treatment, observation group's TIMI flow grade ≥2 was significantly more than the control group , acute vascular reo-cclusion was significantly lower than the con -trol group (χ2 =17.481,χ2 =10.403, P <0.01);after treatment, 2 groups'residual stenosis rate, within 24 h's symptomatic intracranial hemorrhage rate and 3-month mortality differences were not statistically significant (χ2 =3.188,χ2 =0.159,χ2 =0.348, P >0.05).Conclusion Mechanical thrombectomy for the treatment of patients with acute cerebral infarction is bet -ter than the effect of intraa-rterial combined with intravenous thrombolysis , it can improve the neurological function in the ear-lier time,and the long-term prognosis is good .