急性缺血性脑卒中患者血管内治疗的临床效果分析

发布时间：2018-01-15 07:33

本文关键词：急性缺血性脑卒中患者血管内治疗的临床效果分析　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景急性脑卒中是引起人类致残及致死的主要原因之一,已成为导致人类死亡的第二大病因。目前,静脉溶栓是临床上治疗急性脑卒中的标准疗法,但静脉溶栓具有严格的时间窗限制,血管再通率低,尤其是对于大血管闭塞的患者。机械取栓具有快速再通血管、更低的出血转化率、更长的治疗时间窗等优点,引起国内外学者的广泛关注。目前,通常采用支架取栓装置(如Solitaire或Trevo支架)进行血管内治疗,通过支架与外周血管壁的挤压从而捕获血栓、恢复血流,当回撤支架时,可同时移除栓子,具有快速再通血管的理论优势和实践意义、不存在长期并发症的风险。支架取栓对急性脑卒中患者具有重要的治疗价值。目的探讨采用血管内治疗大血管闭塞(Large vessel occlusion,LVO)所致的急性缺血性脑卒中患者的安全性及有效性,并初步探讨全身麻醉(General anesthesia,GA)对患者围手术期以及预后的影响。方法回顾性分析山东大学附属济南市中心医院神经外科于2014年3月至2016年9月期间收治的符合纳入标准的28例急性缺血性脑卒中(Acute ischemic stroke,AIS)患者,经脑血管数字减影检查(Digital subtraction angiography,DSA)确诊为颈部或颅内大血管闭塞,应用SolitaireTM支架在发病6小时内行血管内机械取栓治疗,并在8小时内实现血管再通,所有患者均采用经气管内插管静吸复合全身麻醉。观察患者术后30天、90天改良Rankin量表评分(mRS:0-6分,0分表示无症状,6分表示死亡)、美国国立卫生研究院卒中量表评分(NIHSS:0-42分,分值越高,表示神经功能缺失越严重)评价其治疗的有效性;与操作相关的并发症、颅内出血发生率、90天死亡率评价其治疗的安全性。同时观察麻醉方式对血管内取栓手术开始时间的延误、气管切开比例、肺炎的发生率,并与MR CLEAN研究中全身麻醉组及非全身麻醉组的患者相比较。结果(1)使用Solitaire支架机械取栓的血管再通率为96.4%(27/28),仅1例患者未能即刻开通血管;患者30天及90天神经功能恢复良好者(mRS 0～2分)比例为分别为21.4%(6/28)、50%(14/28)。患者手术后90天的NHISS均值6.7较手术前23.1显著下降(t=9.373,p0.001)。(2)颅内出血发生率为35.7%(10/28),其中症状性颅内出血发生为14.3%(4/28),30天及90天死亡和重度残疾的患者比例(mRS 5-6分)分别占50%(14/28)、32.1%(9/28),没有发生一例手术操作相关的并发症。(3)采用全身麻醉对手术开始的延搁时间平均为19.1分钟,气管切开的比例为 25%(7/28),肺炎发生率为 67.8%(19/28)。结论1.Solitaire支架可安全有效地用于前循环大血管闭塞患者的机械取栓治疗,并可改善急性缺血性脑卒中患者的临床预后。2.与文献中的数据相比,在机械取栓手术中,尽管全身麻醉会延迟血管开通的时间,但并未加重患者的临床预后,该研究初步显示全身麻醉对手术时间的延搁是可以接受的,但仍需通过大规模多中心临床试验来进一步验证。
[Abstract]:Background: acute stroke is caused by one of the major causes of death and disability, has become the second leading cause of human death. At present, intravenous thrombolysis is the standard therapy for the treatment of acute stroke in clinic, but the thrombolytic time window has strict restrictions, the recanalization rate is low, especially for large artery occlusion patients mechanical thrombectomy. With rapid recanalization, lower bleeding conversion rate, longer treatment time window has attracted wide attention of scholars at home and abroad. At present, usually using stent thrombectomy device (such as Solitaire or Trevo support) for endovascular treatment by extrusion, stents and peripheral vascular wall to capture thrombus, restore blood flow, when withdraw support, can also remove emboli, has theoretical advantages and practical significance of rapid revascularization, there is no risk of long-term complications. Stent thrombectomy for acute stroke patients Has important treatment value. Objective to evaluate the endovascular treatment of large vascular occlusion (Large vessel occlusion, LVO) in patients with acute ischemic stroke is safe and effective, and to investigate the general anesthesia (General anesthesia, GA) of surgery and prognosis of patients with peri effect. Methods: retrospective analysis of 28 stroke cases of acute ischemic Department of neurosurgery in Ji'nan Central Hospital Affiliated to Shandong University during March 2014 to September 2016 were accord with the inclusion criteria (Acute ischemic, stroke, AIS) in patients with cerebrovascular digital subtraction angiography (Digital subtraction angiography, DSA) were diagnosed as cervical or intracranial vessel occlusion, application of SolitaireTM stent in endovascular mechanical within 6 hours of onset were suppository in the treatment, and recanalization within 8 hours, all patients were treated with intratracheal intubation general anesthesia were observed. 30 days after the operation, the 90 day modified Rankin scale score (mRS:0-6 points, 0 points indicating no symptoms, 6 deaths, said) National Institute of Health Stroke Scale score (NIHSS:0-42 score, the higher the score, said more serious neurological deficits) evaluation of the effectiveness of the treatment and related operations; complications, incidence of intracranial hemorrhage, 90 day mortality, evaluate the therapeutic safety. And observe the anesthesia on endovascular embolectomy surgery start time delay, the proportion of tracheotomy, the incidence of pneumonia, and general anesthesia with MR in CLEAN patients and non general anesthesia group were compared. Results (1 then through the use of thrombectomy) Solitaire mechanical vascular rate was 96.4% (27/28), only 1 patients failed to immediately open blood vessels; in 30 days and 90 days of nerve function good recovery (mRS 0 ~ 2) ratio were 21.4% (6/28), 50% (14/28) patients 90 days after surgery. NHIS The mean S was 6.7 compared with surgery 23.1 decreased significantly (t=9.373, p0.001). (2) intracranial hemorrhage rate was 35.7% (10/28), the symptomatic intracranial hemorrhage (4/28) was 14.3%, 30 and 90 days of death and the proportion of patients with severe disability (mRS 5-6) accounted for 50% (14/28). 32.1% (9/28), no case of operation related complications. (3) the use of general anesthesia on operation of the delay time for an average of 19.1 minutes, the proportion of tracheotomy was 25% (7/28), the incidence of pneumonia was 67.8% (19/28). Conclusion 1.Solitaire stent is safe and effective for anterior circulation vessel occlusion patients with mechanical thrombectomy, and can improve the clinical outcome of.2. and the patients of acute ischemic stroke compared to the data, in the mechanical embolectomy surgery, although general anesthesia may delay the vascular opening time, but does not increase the clinical prognosis of patients, this preliminary study shows that whole body Anesthesia on operation time delay is acceptable, but still need through large-scale multicenter clinical trials to further verify.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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