动静脉联合溶栓治疗急性脑梗死的临床获益及安全性的meta分析

发布时间：2018-12-21 18:08

【摘要】：背景:急性脑梗死带来的高致死、致残率已成为困扰无数脑卒中病人及家属的噩梦,当前最有效的恢复脑梗塞缺血区再灌注的方法之一就是溶栓治疗,而目前溶栓的方法主要以静脉溶栓和动脉溶栓为主,关于动静脉联合溶栓国内外也有部分相关的报道。目的:本文旨在对动静脉联合溶栓治疗急性缺脑梗塞的临床获益及安全程度进行评估。方法:分别以intravenous thrombolysis,intra-arterial thrombolysis,IA,IV,IA+IV,acute cerebral infarction,acute ischemic stroke,combined,randomized controlled trials等英文词组合检索Pubmed、Cochrane Central Register of Controlled Trials、Embase Database、CNKI、维普数据库、万方全文数据库,收集1999-2016年前的动静脉溶栓治疗急性脑梗死的随机对照试验RCT,根据既定的纳入和排除标准进行试验选择、资料提取、文献质量评估和证据可靠度检验。应用RevMan5.3软件对收集到的数据进行meta分析。结果:纳入1999-2016年间的中英文文献共9篇,总共516例病例,其中动静脉联合溶栓组为240例,行单一溶栓途径(IV/IA)276例。动静脉联合溶栓治疗急性脑梗死相较于单纯动脉或单纯静脉溶栓,其24h、3月后神经功能改善状况及血管再通率均有优势;而症状性脑出血及3-6月死亡率较单纯动脉或静脉溶栓无明显增加。动静脉联合溶栓治疗急性脑梗死的疗效及安全性均在可接受范围内。(1)联合溶栓组神经功能预后改善情况有效率高于单一途径溶栓组:联合溶栓组溶栓24h后的NIHSS评分改善情况优于对照组(OR=2.34,95%CI1.57-3.48,P0.01),联合溶栓组溶栓后3月的mRs评分(0-2)改善优于对照组(OR=1.79,95%CI 1.14-2.82,P=0.01);(2)动静脉联合溶栓的血管再通率高于其他溶栓方法(OR=2.35,95%CI 1.52-3.62,P0.01);(3)联合溶栓组的安全性与对照组相比并没有显著的差异:两组溶栓后继发症状性脑出血的风险无明显差异(OR=0.59,95%0.33-1.07,P=0.08);两组溶栓后死亡风险无显著差异(OR=0.84,95%0.43-1.65,P=0.61)。结论:动静脉联合溶栓治疗急性脑梗塞相较于动脉或静脉溶栓,其溶栓后24h神经功能改善状况和3月短期神经功能预后及血管再通率均有提高;而症状性脑出血及3-6月死亡率较单纯动脉或静脉溶栓无明显增加。动静脉联合溶栓治疗急性缺血性脑卒中的临床获益以及安全程度均在可接受范围内
[Abstract]:Background: the high mortality and disability rate caused by acute cerebral infarction has become a nightmare for numerous stroke patients and their families. Thrombolytic therapy is one of the most effective methods to restore reperfusion in ischemic areas of cerebral infarction. At present, the main methods of thrombolysis are intravenous thrombolysis and arterial thrombolysis. Objective: to evaluate the clinical benefit and safety of combined arteriovenous thrombolysis in the treatment of acute cerebral infarction. Methods: Pubmed,Cochrane Central Register of Controlled Trials,Embase Database,CNKI, Weip database and Wanfang full-text database were retrieved by intravenous thrombolysis,intra-arterial thrombolysis,IA,IV,IA IV,acute cerebral infarction,acute ischemic stroke,combined,randomized controlled trials and other English word combinations, respectively. A randomized controlled trial (RCT,) of arteriovenous thrombolytic therapy for acute cerebral infarction (ACI) from 1999 to 2016 was collected for trial selection, data extraction, literature quality assessment and evidence reliability test according to established inclusion and exclusion criteria. The data collected are analyzed by meta using RevMan5.3 software. Results: there were 9 articles in Chinese and English from 1999 to 2016. A total of 516 cases were included, including 240 cases in arteriovenous thrombolysis group and 276 cases in single thrombolytic pathway (IV/IA). Compared with simple arterial or venous thrombolytic therapy combined with arteriovenous thrombolytic therapy, the improvement of nerve function and the rate of recanalization of blood vessels in 24 h and 3 months after thrombolytic therapy were superior to those of simple arterial or venous thrombolytic therapy. Symptomatic intracerebral hemorrhage and 3-6 months mortality were not significantly increased compared with arterial or venous thrombolysis alone. The efficacy and safety of combined arteriovenous thrombolysis in the treatment of acute cerebral infarction were within acceptable range. (1) the effective rate of nerve function improvement in combined thrombolytic group was higher than that in single thrombolytic group: 24 hours after thrombolytic therapy in combined thrombolytic group The improvement of NIHSS score in control group was better than that in control group (OR=2.34,95%CI1.57-3.48,). The mRs score (0-2) in the combined thrombolytic group was better than that in the control group (OR=1.79,95%CI 1.14-2.82 P0.01). (2) the recanalization rate of arteriovenous thrombolysis was higher than that of other thrombolytic methods (OR=2.35,95%CI 1.52-3.62P0.01). (3) the safety of the combined thrombolytic group was not significantly different from that of the control group: there was no significant difference in the risk of secondary symptomatic intracerebral hemorrhage (OR=0.59,95%0.33-1.07,P=0.08) between the two groups; There was no significant difference in the risk of death after thrombolysis (OR=0.84,95%0.43-1.65,P=0.61) between the two groups. Conclusion: compared with arterial or venous thrombolytic therapy combined with arteriovenous thrombolytic therapy, the improvement of nerve function at 24 hours after thrombolytic therapy, the prognosis of short-term nerve function in 3 months and the recanalization rate of blood vessels were improved. Symptomatic intracerebral hemorrhage and 3-6 months mortality were not significantly increased compared with arterial or venous thrombolysis alone. Clinical benefits and safety of combined arteriovenous thrombolysis in the treatment of acute ischemic stroke are within acceptable limits
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.33

【参考文献】