介入取栓联合静脉溶栓治疗急性缺血性脑卒中的效果研究-国际临床研究杂志-CSCIED科技核心评价数据库-手机版

介入取栓联合静脉溶栓治疗急性缺血性脑卒中的效果研究

A study on the efficacy of combined mechanical thrombectomy and intravenous thrombolysis in acute ischemic stroke

ES评分 0 浏览量：231 下载量：0

DOI	10.12208/j.ijcr.20250557
刊名	国际临床研究杂志 International Journal of Clinical Research
年，卷(期)	2025, 9(11)
作者	李汉城, 佘寅虎,
作者单位	十堰市中西医结合医院湖北十堰
摘要	目的评估静脉溶栓（IVT）联合机械取栓（MT）对前循环急性大血管闭塞性缺血性脑卒中（AIS-LVO）患者的血管再通率、早期神经功能改善、90d预后及安全性。方法选取2023年1月至2025年6月湖北省3个高级卒中中心前瞻性数据库中发病6 h内完成血管内治疗的AIS-LVO患者428例。根据是否接受IVT分为观察组（IVT+MT，n=238）与对照组（MT，n=190）。主要结局为术后24 h有效再通（mTICI≥2b），次要结局包括早期神经功能改善（ΔNIHSS≥4）、90 d良好预后（mRS 0-2）、症状性颅内出血（sICH）及90 d全因死亡。采用多因素Logistic 回归及倾向评分匹配（PSM，1:1，卡钳值 0.02）校正混杂。结果观察组基线NIHSS更高（17.4±5.0 vs 15.9±4.5，P=0.003），发病至穿刺时间无差异。观察组 24 h再通率显著升高（90.8 % vs 80.5 %，P=0.002），早期神经功能改善率（62.6 % vs 47.9 %，P=0.001）及90 d良好预后率（57.6 % vs 43.2 %，P=0.002）亦优于对照组；sICH（4.6 % vs 4.2 %，P=0.789）与90 d死亡率（7.6 % vs 9.5 %，P=0.421）差异无统计学意义。PSM 后获得152对，结果一致。多因素分析显示，桥接治疗（OR=1.96，95 %CI 1.15-3.34）、ASPECTS≥8（OR=2.20，95 %CI 1.23–3.95）及发病至再通≤300 min（OR=1.91，95 %CI 1.06–3.44）是90 d良好预后的独立保护因素。结论 IVT桥接MT可安全有效地提高AIS-LVO患者血管再通率并改善90 d临床结局，推荐在时间窗内常规实施桥接策略。
Abstract	Objective To evaluate the recanalization rate, early neurological improvement, 90-day prognosis, and safety of intravenous thrombolysis (IVT) combined with mechanical thrombectomy (MT) in patients with acute large vessel occlusion ischemic stroke (AIS-LVO) in the anterior circulation. Methods A total of 428 patients with AIS-LVO who underwent endovascular treatment within 6 hours of symptom onset were selected from the prospective databases of three advanced stroke centers in Hubei Province between January 2023 and June 2025. Patients were divided into an observation group (IVT+MT, n=238) and a control group (MT, n=190) based on whether they received IVT. Primary outcome: effective reperfusion at 24 hours post-intervention (mTICI ≥2b). Secondary outcomes: early neurological improvement (ΔNIHSS ≥4), favorable 90-day outcome (mRS 0-2), symptomatic intracranial hemorrhage (sICH), and 90-day all-cause mortality. Multivariate logistic regression and propensity score matching (PSM, 1:1, cutoff 0.02) were used to adjust for confounders. Results The observation group had a higher baseline NIHSS (17.4±5.0 vs 15.9±4.5, P=0.003), with no difference in time from onset to puncture. The observation group demonstrated significantly higher 24-hour recanalization rates (90.8% vs 80.5%, P=0.002), early neurological improvement rates (62.6% vs 47.9%, P=0.001), and 90-day favorable outcome rates (57.6% vs 43.2%, P=0.002) compared to the control group. No statistically significant differences were observed in sICH (4.6% vs 4.2%, P=0.789) or 90-day mortality (7.6% vs 9.5%, P=0.421). Post-PSM analysis yielded 152 matched pairs with consistent results. Multivariate analysis identified bridging therapy (OR=1.96, 95% CI 1.15-3.34), ASPECTS ≥8 (OR=2.20, 95% CI 1.23–3.95), and time-to-reperfusion ≤300 min (OR=1.91, 95% CI 1.06–3.44) were independent protective factors for favorable 90-day outcomes. Conclusion IVT bridging MT safely and effectively increases recanalization rates and improves 90-day clinical outcomes in AIS-LVO patients. Routine implementation of bridging strategies within the time window is recommended.
关键词	急性缺血性脑卒中；大血管闭塞；静脉溶栓；机械取栓；桥接治疗；疗效
KeyWord	Acute ischemic stroke; Large vessel occlusion; Intravenous thrombolysis; Mechanical thrombectomy; Bridging therapy; Efficacy
基金项目
页码	179-182

参考文献
相关文献

[1] 张健,高宇,张平,等 . 侧支循环与机械取栓后成功再通的急性缺血性脑卒中患者预后的相关性
[J]. 新乡医学院学报,2024,41(6):543-547.

[2] Suzuki K, Matsumaru Y, Takeuchi M, et al. Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: the SKIP randomized clinical trial. JAMA, 2021, 325: 244-253.

[3] 张一旭,潘盈盈,俞月婷.急性缺血性脑卒中合并颅内多发动脉瘤溶栓患者护理1例
[J].中国乡村医药,2024, 31(18):57-59.

[4] 邱凯,施海彬,祖庆泉,等.院内急性缺血性脑卒中机械取栓治疗效果和预后因素分析介人放射学杂志,2021, 30(2): 118-122

[5] 尹惠广,黄贤键,张悦,等.东莞市青年急性缺血性脑卒中危险因素分析
[J].吉林医学,2024,45(9):2206-2211.

[6] 聂莉媛,王潇慧,王楠.进展性缺血性脑卒中与中医体质相关性探讨
[J].光明中医,2024,39(17):3400-3403.

[7] Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke: a non-inferiority study. Dev Med, 2020, 396: 401-410.

[8] DIRECT-MT Investigators. Direct intra-arterial thrombectomy vs combined intravenous and intra-arterial thrombolysis in acute ischemic stroke. N Engl J Med, 2020, 382: 2283-2294.

[9] 林志超,潘思金,谢玉龙,等.急性缺血性脑卒中静脉溶栓预后不良预警模型构建
[J]. 中国医学物理学杂志,2024, 41(4):421-425.

[10] MR CLEAN-NO IV Investigators. Intravenous thrombolysis before endovascular treatment in acute ischemic stroke. Lancet, 2022, 400: 1045-1054.

[11] Macha K, Hassan AE, Reznik M, et al. Microvascular perfusion improvement after bridging thrombolysis: an MRI study. J Neurointerv Surg, 2022, 14: 223-228.

[12] 罗佳,马骏.急性缺血性脑卒中患者颅内血栓成分及调节性T细胞表达与患者临床结局的相关性
[J]. 浙江大学学报(医学版),2024,53(2):160-167.

[13] 林志超, 潘思金, 谢玉龙,等.急性缺血性脑卒中静脉溶栓预后不良预警模型构建
[J]. 中国医学物理学杂志, 2024,41(4):421-425.

引用本文

李汉城, 佘寅虎. 介入取栓联合静脉溶栓治疗急性缺血性脑卒中的效果研究 [J]. 国际临床研究杂志. 2025; 9; (11). 179 - 182.

文献评论

相关学者

相关机构