| Objective:To investigate the effectiveness and safety of different treatment regimens for acute ischemic stroke with UK,rt-PA intravenous thrombolysis,mechanical thrombectomy and conventional drug therapy.And to analyze the causes of no intravenous thrombolysis and mechanical thrombectomy in patients with acute ischemic stroke.Methods:Continuously collected 533 patients with acute ischemic stroke in time window and hospitalized in the Department of Neurology,Second Hospital of Jilin University from January 2017 to December 2018.According to the different treatment methods,it was divided into rt-PA group,UK group,thrombectomy group and conventional treatment group.In the conventional treatment group,the baseline of the pre-treatment NIHSS score was similar to this in the thrombectomy group as the conventional severe group.Each group of patients recorded gender,age,current medical history,past history,personal history,onset and treatment time,first-time doctor-patient communication record information,and intravenous thrombolysis(mechanical thrombectomy)informed consent,Causes of no intravenous thrombolysis(mechanical thrombectomy).The thrombectomy group independently recorded the occlusion site of the blood vessel,number of thrombus removals,whether the thrombolysis was performed before the thrombectomy,and whether the remedial measures(ball balloon dilatation or stent implantation)was used after the thrombectomy.The short-term effects were evaluated by comparing the changes of NIHSS scores before treatment,24 h and 7d after treatment.Long-term efficacy was assessed by comparing 90 dmRS scores.Safety was assessed by comparing intracranial hemorrhage conversion rates and mortality.Results:There were 533 patients with acute ischemic stroke within 6 hours of onset,including 176 cases of intravenous thrombolysis(including 111 cases of rt-PA intravenous thrombolysis and 63 cases of UK intravenous thrombolysis),accounting for 32.7%;55 patients were treated with mechanical thrombectomy,accounting for 10.3%,304 patients were treated with conventional drugs,accounting for 57.0%,and 70 patients were in conventional severe group,accounting for 23.0%.The NIHSS scores of the groups were lower than those before treatment at 24 h and 7d after treatment,and showed a decreasing trend.The NIHSS scores of rt-PA group,UK group and thrombectomy group were more significant,and the differences were statistically significant(P<0.05).The good prognosis ratio(mRS 0-2)in the rt-PA group and the UK group was significantly higher than that in the thrombectomy group and the conventional treatment group(P<0.05).There was no significant difference in intracranial hemorrhage conversion rate and mortality between rt-PA group,UK group and conventional treatment group(P>0.05),but the conversion rate and mortality of intracranial hemorrhage in the thrombectomy group were significantly higher than the other groups.Academic significance(P<0.05).Compared with the conventional severe group,the NIHSS score was significantly lower at 7 days after treatment(P<0.05),and the good prognosis at 90 days(mRS 0-2)was significantly higher(49.1% vs 25.6%,P<0.05).There was no significant difference in the conversion rate and mortality of intracranial hemorrhage(P<0.05).Among the 55 patients in the thrombectomy group,13 had middle cerebral artery occlusion,15 had internal carotid artery occlusion,26 had basilar artery occlusion,and 1 had cerebral anterior artery occlusion.Vascular recanalization rate is 80%.Three patients with anterior circulation large vessel occlusion were treated with intravenous thrombolysis and mechanical thrombectomy.All of them achieved recanalization and obtained a good functional prognosis for 90 days without bleeding and death.17 patients with remedial measures(balloon dilatation or stent implantation)showed a significant improvement in NIHSS scores 7 days after treatment(P<0.05)and a revascularization rate of 76.5%,the 90-day prognosis rate was 47.0%,the mortality rate was 17.7%,and no intracranial hemorrhage occurred.The number of bolts taken was 1-5 times,with an average of 1.87±0.86 times.There was no significant difference in the reduction of NIHSS score,the proportion of good prognosis at 90 days(50.0% vs44.4%),intracranial hemorrhage rate(8.7% vs 11.1%)and mortality(17.4% vs 22.2%)between patients with thrombosis removed more than or equal to 2 times and less than 2 times(P>0.05).304 patients in the conventional treatment group,accounting for 57.0%.Among them,69 cases exceeded the time window after admission,accounting for 22.70%;58 cases of arousal stroke,accounting for 19.08%;55 cases of light stroke,accounting for 18.09%;32 cases of age > 80 years old,accounting for 10.53%;22 cases of neurological function improved after admission,accounting for 7.24%;the patient refused 10 cases,accounting for 3.29%;blood pressure was too high in 10 cases,accounting for 3.29%;severe neurological dysfunction in 5 cases,accounting for 1.64%;previous history of cerebral hemorrhage in 8 cases,accounting for 2.63%;low platelets 7 cases,accounting for 2.30%;oral anticoagulant and abnormal coagulation indicators in 2 cases,accounting for 0.66%;other reasons 26 cases,accounting for 8.55%.Conclusion:1.The use of rt-PA,UK intravenous thrombolysis,mechanical thrombectomy and conventional drug treatment can improve the prognosis of patients with AIS.The therapeutic effect of intravenous thrombolysis and mechanical thrombectomy is better than conventional drugs.2.Intravenous thrombolysis does not increase the risk of intracranial hemorrhage and death compared with conventional treatment;Intracranial hemorrhage and mortality from mechanical thrombectomy are higher than intravenous thrombolysis and conventional medication.However,patients with the same neurological deficits did not increase their risk of intracranial hemorrhage and death.3.Pre-hospital delay,in-hospital delay,patient rejection,absolute or relative contraindications are the main reasons why patients cannot undergo intravenous thrombolysis(mechanical thrombectomy).Therefore,AIS national health education and green channel management should be further strengthened. |
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