目的 对出现大脑中动脉阻塞的缺血性卒中患者分别行动脉溶栓与静脉溶栓,并将两者进行比较.方法 分别在两个卒中单元对大脑中动脉阻塞的缺血性卒中患者进行治疗.一个卒中单元对发病后6 h内的患者采用尿激酶(urokinase)动脉溶栓的治疗方案,另一个卒中单元对发病后3 h内的患者采用纤维蛋白溶酶原激活剂(plasminogen activator,PA)静脉溶栓的治疗方案.利用病死率及改良Rankin量表(modified Rankin scale,mRS)来评估预后情况:3个月后mRS评分为0~2分者为预后良好,3个月后mRS评分为3~6分者为预后不良.最后,将两个卒中单元的数据资料进行比较.结果 共计115例缺血性卒中患者CT显示大脑中动脉阻塞:58例行动脉溶栓治疗(动脉溶栓组),57例行静脉溶栓治疗(静脉溶栓组).两个卒中单元收治患者的卒中严重程度及年龄均相似.动脉溶栓组自发病至治疗的平均时间为(244±63)min,静脉溶栓组自发病至治疗的平均时间为(156±21) min,差异有统计学意义(P＜0.0001).动脉溶栓组的预后良好率为56.9%(29/51),高于静脉溶栓组的30.2%(13/43),差异有统计学意义(χ2=9.165,P＝0.012);动脉溶栓组的病死率为12.1%(7/58),低于静脉溶栓组的24.6%(14/57),差异有统计学意义(χ2=3.006,P＝0.081).经多元回归分析发现,动脉溶栓与静脉溶栓相比,预后更好(P=0.003)、病死率相似(P＝0.133).结论 尽管动脉溶栓自发病至开始治疗的时间更长,但动脉溶栓的疗效较静脉溶栓的疗效好.%Objective To compare IAT and IVT in patients with MCA occlusion.Methods Patients with MCA occlusion were treated in two stroke units, of which one unit was treated by urokinase IAT within 6 hours of onset and the other unit by plasminogen activator IVT within 3 hours of onset.Prognosis was assessed by mortality and modified Rankin Scale ( mRS ).After 3 months, the prognosis could be divided into favorable ( mRS score 0 to 2 ) and unfavorable ( mRS score 3 to 6 ).Data of the two units were then compared.Results A total of 102 patients were shown MCA occlusion by CT, among which 58 patients were treated by IAT and 57 patients by IVT.Stroke severity at baseline and patient age were similar in both groups.Mean time to treatment was significantly longer in the IAT group [( 244 ±63 ) minutes]than in the IVT group [( 156 ±21 ) minutes]( P ＜0.0001 ).However, favorable outcome was significantly more frequent after IAT ( 56.9％ , 29/51 ) than that after IVT ( 30.2％ , 13/43 ) ( x2 =9.165 , P =0.012 ), and mortality was significantly lower after IAT ( 12.1％ , 7/58 ) than that after IVT ( 24.6％ , 14/57 ) ( x2 = 3.006, P = 0.081 ).Multiple regression analysis showed that IAT was associated with a more favorable outcome compared with IVT ( P =0.003 ) but they had similar mortality ( P =0.133 ).Conclusion In this observational study, intraarterial thrombolysis is more beneficial than IVT in the specific group of stroke patients presenting with HMCAS by CT, even though IAT started later.
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