临床神经病学杂志2026，Vol.39Issue(4)：241-245,5.
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
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
摘要
Abstract
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.关键词
直接取栓/阿替普酶/高血栓负荷/脑梗死/大血管闭塞Key words
direct thrombectomy/alteplase/high thrombus load/cerebral infarction/large vessel occlusion分类
医药卫生引用本文复制引用
闫妍,王琳,乔玉,王丽云,国腾飞..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[J].临床神经病学杂志,2026,39(4):241-245,5.基金项目
河北省2025 年度医学科学研究课题计划项目(20251417) （20251417）
