直接取栓与阿替普酶溶栓后取栓对6h内高血栓负荷大血管闭塞性脑梗死的疗效及安全性比较OA
Effects and safety of direct thrombectomy and alteplase followed by thrombolysis on cerebral infarction with high thrombus load and large vessel occlusion within 6 h
目的 比较直接取栓与阿替普酶溶栓桥接血管内取栓对 6h 内高血栓负荷大血管闭塞性脑梗死疗效及安全性.方法 根据治疗方式的不同将120 例发病 6h 内的高血栓负荷大血管闭塞性脑梗死患者分为直接取栓组67 例和桥接取栓组53 例.比较两组患者的取栓时间、良好功能结局率、NIHSS 评分、神经损伤标志物[神经生长因子(NGF)、神经元特异性烯醇化酶(NSE)和脑源性神经营养因子(BDNF)]水平和出血情况.结果 直接取栓组和桥接取栓组入院至检查时间、入院至穿刺时间以及动脉穿刺至血管再通时间、取栓次数、血栓逃逸比率、mRS 评分与良好功能结局率差异无统计学意义(均 P>0.05).与术前比较,直接取栓组和桥接取栓组术后3 d、7 d、30 d 的 NIHSS 评分显著下降(均 P<0.05).直接取栓组和桥接取栓组术前及术后3 d、7 d、30 d 的 NIHSS 评分差异无统计学意义(均 P>0.05).与术前比较,直接取栓组和桥接取栓组术后30 dNGF、BDNF 水平显著上升,NSE 水平显著下降(均 P<0.05).直接取栓组和桥接取栓组术前及术后30 dNGF、NSE、BDNF 水平差异无统计学意义(均P>0.05).直接取栓组出血转化率显著低于桥接取栓组(P<0.05),两组自发性脑出血率差异无统计学意义(P>0.05).结论 直接取栓与阿替普酶溶栓桥接血管内取栓能够使6h 内高血栓负荷大血管闭塞性脑梗死患者获得相似的疗效,但直接取栓的出血转化率更低,具有更高的安全性.
Objective To compare the effect and safety of direct thrombectomy and alteplase followed by thrombolysis on cerebral infarction with high thrombus load and large vessel occlusion within 6 h.Methods According to the different treatment methods,120 patients with large vessel occlusive cerebral infarction with high thrombus load within 6 h of onset were divided into the direct thrombectomy group(67 cases)and the bridging thrombectomy group(53 cases).The thrombectomy time,good functional outcome rate,NIHSS score,nerve injury markers[nerve growth factor(NGF),neuron-specific enolase(NSE)and brain-derived neurotrophic factor(BDNF)]levels and bleeding were compared between the two groups.Results There was no significant difference in admission to examination time,admission to puncture time,arterial puncture to vascular recanalization time,number of thrombectomy,thrombus escape rate,mRS score and good functional outcome rate between the direct thrombectomy group and the bridging thrombectomy group(all P>0.05).Compared with those before operation,the NIHSS scores at 3 d,7 d and 30 d after operation of the direct thrombectomy group and the bridging thrombectomy group were significantly decreased(all P<0.05).There was no significant difference in NIHSS score between the direct thrombectomy group and the bridging thrombectomy group before operation and at 3 d,7 d and 30 d after operation(all P>0.05).Compared with those before operation,the levels of NGF and BDNF at 30 d after operation in the direct thrombectomy group and the bridging thrombectomy group were significantly increased,and the level of NSE was significantly decreased(all P<0.05).There was no significant difference in the levels of NGF,NSE and BDNF between the direct thrombectomy group and the bridging thrombectomy group before and 30 d after operation(all P>0.05).The conversion rate of bleeding in the direct thrombectomy group was significantly lower than that in the bridging thrombectomy group(P<0.05),and there was no significant difference in the rate of spontaneous non-traumatic symptomatic cerebral hemorrhage between the two groups(P>0.05).Conclusion Direct thrombectomy and alteplase thrombolysis bridging intravascular thrombectomy can achieve similar efficacy in patients with high thrombus load large vessel occlusive cerebral infarction within 6 h,but the bleeding conversion rate of direct thrombectomy is lower and has higher safety.
闫妍;王琳;乔玉;王丽云;国腾飞
054000 邢台市人民医院神经内六科054000 邢台市人民医院神经内四科054000 邢台市人民医院神经内四科054000 邢台市人民医院神经内四科隆尧县医院神经内一科
医药卫生
直接取栓阿替普酶高血栓负荷脑梗死大血管闭塞
direct thrombectomyalteplasehigh thrombus loadcerebral infarctionlarge vessel occlusion
《临床神经病学杂志》 2026 (4)
241-245,5
河北省2025 年度医学科学研究课题计划项目(20251417)
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