静脉溶栓机械取栓在治疗急性缺血性脑卒中患者中的应用

肖淑烽; 陈艳丽; 郭俊; 余芬; 杨唐柱

doi:10.14188/j.1671-8852.2024.0183

您当前的位置：

首页 >

文章列表页 >

静脉溶栓机械取栓在治疗急性缺血性脑卒中患者中的应用

临床医学研究 | 更新时间：2026-11-05

- 静脉溶栓机械取栓在治疗急性缺血性脑卒中患者中的应用
- Application of intravenous thrombolysis and mechanical thrombectomy in the treatment of acute ischemic stroke
- 武汉大学学报（医学版） 2025年46卷第9期页码：1190-1194
- 作者机构：
  
  1.湖北省天门市第一人民医院神经内科湖北天门 431700
  2.武汉市第三医院神经内科湖北武汉 430060
  3.华润武钢总医院神经内科湖北武汉 430080
- 作者简介：
  
  肖淑烽，女，1983—，主治医师，主要从事神经内科疾病研究，E‑mail：xiaosf1213@163.com
- 基金信息：
  
  湖北省卫生健康委员会资助项目(WJ2019H167)
- DOI：10.14188/j.1671-8852.2024.0183
  中图分类号： R743
- 收稿：2024-03-17，
  
  纸质出版：2025-09-26
- 稿件说明：
移动端阅览
肖淑烽,陈艳丽,郭俊等.静脉溶栓机械取栓在治疗急性缺血性脑卒中患者中的应用[J].武汉大学学报（医学版）,2025,46(09):1190-1194.

XIAO Shufeng,CHEN Yanli,GUO Jun,et al.Application of intravenous thrombolysis and mechanical thrombectomy in the treatment of acute ischemic stroke[J].Medical Journal of Wuhan University,2025,46(09):1190-1194.
肖淑烽,陈艳丽,郭俊等.静脉溶栓机械取栓在治疗急性缺血性脑卒中患者中的应用[J].武汉大学学报（医学版）,2025,46(09):1190-1194. DOI： 10.14188/j.1671-8852.2024.0183.

XIAO Shufeng,CHEN Yanli,GUO Jun,et al.Application of intravenous thrombolysis and mechanical thrombectomy in the treatment of acute ischemic stroke[J].Medical Journal of Wuhan University,2025,46(09):1190-1194. DOI： 10.14188/j.1671-8852.2024.0183.

摘要

目的

探讨急性缺血性脑卒中（ACI）采用静脉溶栓、机械取栓治疗的临床效果。

方法

选取2022年2月—2023年2月湖北省天门市第一人民医院收治的90例ACI患者，按照治疗方法不同进行分组，对照组采取静脉溶栓治疗（

=48），研究组在此基础上联合机械取栓治疗（

=42），对比两组患者的治疗疗效、不良反应，并随访90 d，观察治疗前后的美国国立卫生研究院卒中量表（NIHSS）评分以及患者的预后情况。

结果

与对照组比较，研究组治疗疗效更高

（

0.05），研究组不良反应率较低（

0.05）。治疗前，两组NIHSS评分比较差异无统计学意义（

0.05），治疗后均有所降低（

0.05），与对照组相比，研究组治疗1 d、3 d、30 d以及90 d的NIHSS评分更低（

0.05）。以90 d为期限观察两组患者的预后，两组患者病死率比较差异无统计学意义（

0.05）；与对照组比较，研究组TICI≥2b级率更高、血管急性再闭塞率更低（

0.05）。

结论

静脉溶栓联合机械取栓用于ACI患者的治疗，疗效有效且安全，能够减轻患者的神经功能缺损程度，提高闭塞血管再通率。

Abstract

Objective

To investigate the clinical efficacy of intravenous thrombolysis and mechanical thrombectomy in the treatment of acute ischemic stroke (ACI).

Methods

Ninety patients with ACI admitted to the First People's Hospital of Tianmen in Hubei Province from February 2022 to February 2023 were enrolled and divided into two groups according to different treatment methods. The control group was treated with intravenous thrombolysis (

=48)

and the intervention group was treated with mechanical thrombectomy on the basis of intravenous thrombolysis (

=42). The therapeutic efficacy and adverse reactions of the two groups were compared

and the patients were followed up for 90 days to observe the National Institute of Health Stroke Scale (NIHSS) score before and after treatment and the prognosis of the patients.

Results

Compared with that in the control group

the curative effect of the intervention group was higher (

0.05). The adverse reaction rate of the study group was lower (

0.05). There was no difference in NIHSS score between the two groups before treatment (

0.05)

but it decreased after treatment (

0.05). Compared with that respectively in the control group

the NIHSS score of the study group was lower at 1 d

3 d

30 d and 90 d after treatment

respectively (

0.05). There was no d

ifference in mortality between the two groups (

0.05). Compared with that in the control group

the rate of TICI≥2b was higher and the rate of acute reocclusion was lower in the intervention group (

0.05).

Conclusion

Intravenous thrombolysis combined with mechanical thrombectomy is effective and safe in the treatment of ACI patients

which can reduce the degree of neurological deficit and improve the recanalization rate of occluded vessels.

关键词

Keywords

references

JOLUGBO P , ARIËNS R A S . Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke [J ] . Stroke , 2021 , 52 ( 3 ): 1131 ‑ 1142 .

俞月婷 , 胡平浪 , 张一旭 . 脑卒中后遗症期患者社交障碍的现况调查及影响因素分析 [J ] . 护理与康复 , 2020 , 19 ( 12 ): 5 ‑ 9 .

YU Y T , HU P L , ZHANG Y X . Present status investigation and influencing factors analysis on social intercourse disorder of patients with sequel stage of stroke [J ] . J Nurs Rehabil , 2020 , 19 ( 12 ): 5 ‑ 9 .

SANG H F , XIE D J , TIAN Y , et al . Association of tirofiban with functional outcomes after thrombectomy in acute ischemic stroke due to intracranial atherosclerotic disease [J ] . Neurology , 2023 , 100 ( 19 ): e1996 ‑ e2006 .

BERGE E , WHITELEY W , AUDEBERT H , et al . European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke [J ] . Eur Stroke J , 2021 , 6 ( 1 ): Ⅰ‑LⅫ.

SHRESTHA B , WICHAI W , SRIKHIRIN T , et al . Impact of household vinegar on calculus removal and mechanical properties of orthodontic resin [J ] . J Orofac Orthop , 2021 , 82 ( 1 ): 54 ‑ 63 .

中华医学会神经病学分会 , 中华医学会神经病学分会脑血管病学组 . 中国急性缺血性脑卒中诊治指南2018 [J ] . 中华神经科杂志 , 2018 , 51 ( 9 ): 666 ‑ 682 .

Society of Neurology of Chinese Medical Association , Cerebrovascular Disease Group of Society of Neurology of Chinese Medical Association . Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018 [J ] . Chin J Neurol , 2018 , 51 ( 9 ): 666 ‑ 682 .

ZHU A N , RAJENDRAM P , TSENG E , et al . Alteplase or tenecteplase for thrombolysis in ischemic stroke: An illustrated review [J ] . Res Pract Thromb Haemost , 2022 , 6 ( 6 ): e12795 .

JADHAV A P , DESAI S M , JOVIN T G . Indications for mechanical thrombectomy for acute ischemic stroke: Current guidelines and beyond [J ] . Neurology , 2021 , 97 (20 Suppl 2 ): S126 ‑ S136 .

李凤利 , 王金晶 , 戴征 , 等 . 机械血栓切除术后“成功”再通的前循环卒中患者的转归: TICI3与TICI2b比较 [J ] . 国际脑血管病杂志 , 2017 , 25 ( 5 ): 406 ‑ 411 .

LI F L , WANG J J , DAI Z , et al . Outcomes in patients with "successful" recanalization in anterior circulation stroke treated with mechanical thrombectomy: TICI 3 versus TICI 2b [J ] . Int J Cerebrovasc Dis , 2017 , 25 ( 5 ): 406 ‑ 411 .

ALEMSEGED F , ROCCO A , ARBA F , et al . Posterior national institutes of health stroke scale improves prognostic accuracy in posterior circulation stroke [J ] . Stroke , 2022 , 53 ( 4 ): 1247 ‑ 1255 .

QIU Y M , ZHANG C L , CHEN A Q , et al . Immune cells in the BBB disruption after acute ischemic stroke: Targets for immune therapy? [J ] . Front Immunol , 2021 , 12 : 678744 .

MENDELSON S J , PRABHAKARAN S . Diagnosis and management of transient ischemic attack and acute ischemic stroke: A review [J ] . JAMA , 2021 , 325 ( 11 ): 1088 ‑ 1098 .

VÁCLAVÍK D , VOLNÝ O , CIMFLOVÁ P , et al . The importance of CT perfusion for diagnosis and treatment of ischemic stroke in anterior circulation [J ] . J Integr Neurosci , 2022 , 21 ( 3 ): 92 .

马飞 , 余龙伍 , 姜勇 , 等 . 阿替普酶溶栓治疗急性缺血性脑卒中的效果及对神经功能和脑血管储备功能的影响 [J ] . 西北药学杂志 , 2023 , 38 ( 4 ): 188 ‑ 192 .

MA F , YU L W , JIANG Y , et al . Efficacy of alteplase intravenous thrombolysis in the treatment of acute ischemic stroke and its effects on neurological function and cerebrovascular reserve function [J ] . Northwest Pharm J , 2023 , 38 ( 4 ): 188 ‑ 192 .

BRACARD S , DUCROCQ X , MAS J L , et al . Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): A randomised controlled trial [J ] . Lancet Neurol , 2016 , 15 ( 11 ): 1138 ‑ 1147 .

孟凯涛 , 张建国 , 刘崇 , 等 . Solitaire AB支架机械取栓联合阿替普酶静脉溶栓对急性缺血性脑卒中患者的临床研究 [J ] . 现代生物医学进展 , 2022 , 22 ( 1 ): 131 ‑ 135 .

MENG K T , ZHANG J G , LIU C , et al . Clinical study of mechanical thrombectomy with solitaire AB stent and intravenous thrombolysis with alteplase in patients with acute ischemic stroke [J ] . Prog Mod Biomed , 2022 , 22 ( 1 ): 131 ‑ 135 .

侯凯文 , 李沛城 , 陈珑 , 等 . 机械取栓术治疗急性缺血性脑卒中伴恶性肿瘤患者效果分析 [J ] . 介入放射学杂志 , 2022 , 31 ( 9 ): 852 ‑ 856 .

HOU K W , LI P C , CHEN L , et al . Mechanical thrombectomy for acute ischemic stroke in patients with a current or previous malignancy: Analysis of its curative effect [J ] . J Interv Radiol , 2022 , 31 ( 9 ): 852 ‑ 856 .

田伟 , 杨章超 , 马文群 , 等 . 超高龄急性缺血性脑卒中病人行可回收支架机械取栓的效果及安全性 [J ] . 实用老年医学 , 2023 , 37 ( 4 ): 378 ‑ 381 .

TIAN W , YANG Z C , MA W Q , et al . Effect and safety of mechanical thrombectomy with retrievable stent in advanced aged patients with acute ischemic stroke [J ] . Pract Geriatr , 2023 , 37 ( 4 ): 378 ‑ 381 .

常小娜 , 钟立清 , 刘应 , 等 . Solitaire AB型支架机械取栓术联合静脉溶栓治疗前循环急性缺血性脑卒中的疗效 [J ] . 中国实用神经疾病杂志 , 2023 , 26 ( 1 ): 19 ‑ 24 .

CHANG X N , ZHONG L Q , LIU Y , et al . Effect of Solitaire AB stent mechanical embolectomy combined with intravenous thrombolysis for acute ischemic stroke in anterior circulation [J ] . Chin J Pract Nerv Dis , 2023 , 26 ( 1 ): 19 ‑ 24 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

单独静脉输注阿替普酶与联合阿加曲班对急性缺血性脑卒中治疗效果的Meta分析

急性缺血性脑卒中NLRP3的变化及其与神经功能缺损的关系

NNRG/ErbB通路在静脉溶栓治疗急性脑卒中的作用

替格瑞洛联合尿激酶对急性心肌梗死患者溶栓效果、血小板聚集率和炎症因子的影响

静脉血栓栓塞症预防健康教育的研究进展