Department of Stroke Ward, Affiliated Hospital of Beihua University, Jilin City, Jilin Province, China.
Eur Rev Med Pharmacol Sci. 2018 Sep;22(17):5740-5746. doi: 10.26355/eurrev_201809_15842.
This study aims to compare clinical efficiency of mechanical thrombectomy combined with rhPro-UK thrombolysis on moderate or severe acute brain infarction.
A total of 90 acute cerebral infarction patients due to artery stenosis or blockade from May 2016 to May 2017 were recruited and randomly assigned into thrombolysis group (N = 30), mechanical thrombectomy (N = 30), and combined treatment group (N = 30). Clinical information was collected. Thrombolysis group received rhPro-UK, mechanical thrombectomy group received Solitaire scaffold, and combined group received rhPro-UK after Solitaire scaffold. Barthel scale and NIHSS scale were used to evaluate the quality of life and mental deficit of patients. Modified thrombolysis in cerebral infarction (mTICI) was compared among three groups, along with the observation of hemorrhage, neurological recovery within 90 days, and adverse effects.
No significant difference was found in NIHSS within 24 h of treatment among three groups (p > 0.05), but the decreasing levels were shown at 24 h, 7 days, and 90 days comparing to those before treatment (p < 0.05). In combined treatment group, lower NIHSS at 7 d and 90 d were detected comparing to other two groups (p < 0.05). Recanalization rates were 53.33% and 60.00% in thrombolysis and mechanical groups (p > 0.05), respectively, which were significantly lower than that in combined group (83.33%) (p < 0.05). Curative rate in combined group was 70%, significantly higher than thrombolysis (46.67%) and mechanical group (53.33%) (p < 0.05). No statistical difference of curative rate was observed between thrombolysis and mechanical groups (p > 0.05). Moreover, neither significant difference of coagulation function nor platelet count was found among three groups (p > 0.05).
Mechanical thrombectomy combined with thrombolysis presented favorable efficiency in the treatment of moderate to severe acute cerebral infarction than single treatment, among which the occurrence of adverse effects were similar.
本研究旨在比较机械血栓切除术联合 rhPro-UK 溶栓治疗中度或重度急性脑梗死的临床疗效。
共纳入 90 例因动脉狭窄或阻塞导致的急性脑梗死患者，于 2016 年 5 月至 2017 年 5 月接受治疗，随机分为溶栓组（n = 30）、机械血栓切除术组（n = 30）和联合治疗组（n = 30）。收集临床资料。溶栓组接受 rhPro-UK 治疗，机械血栓切除术组接受 Solitaire 支架治疗，联合组在 Solitaire 支架后接受 rhPro-UK 治疗。采用 Barthel 量表和 NIHSS 量表评估患者的生活质量和精神缺陷。比较三组改良脑梗死溶栓（mTICI），观察出血、90 天内神经功能恢复情况和不良反应。
三组治疗后 24 h NIHSS 无显著差异（p > 0.05），但与治疗前相比，24 h、7 d 和 90 d 下降水平均降低（p < 0.05）。联合治疗组在第 7 天和第 90 天的 NIHSS 评分低于其他两组（p < 0.05）。溶栓组和机械组的再通率分别为 53.33%和 60.00%（p > 0.05），明显低于联合组（83.33%）（p < 0.05）。联合组的有效率为 70%，明显高于溶栓组（46.67%）和机械组（53.33%）（p < 0.05）。溶栓组和机械组的有效率无统计学差异（p > 0.05）。此外，三组凝血功能和血小板计数无统计学差异（p > 0.05）。
机械血栓切除术联合溶栓治疗中重度急性脑梗死的疗效优于单一治疗，且不良反应发生率相似。
