血管内介入治疗后循环急性脑梗死85例临床分析

发布时间：2018-04-03 02:34

  本文选题：脑梗死　切入点：后循环　出处：《吉林大学》2014年硕士论文

【摘要】：目的： 本文探讨动脉溶栓、辅助机械再通治疗急性VBO所致后循环脑梗死的治疗效果及其并发症。 材料和方法： 回顾性分析近5年因VBO导致的后循环急性脑梗死患者85例，其中单纯动脉溶栓治疗57例，辅助机械再通28例。选择同时期内科药物治疗的VBO导致的后循环急性脑梗死患者50例作为对照组。收集患者年龄、发病到治疗时间、血管再通情况、90d临床预后等，并进行统计分析。介入治疗组临床结果评价在术后90ｄ进行（对照组在发病后90ｄ进行），根据改良的Rank评分（modified Rankin Scale，mRS），0～2分为预后良好、3～5分为不佳、6分为死亡；在介入治疗组中将神志清醒和嗜睡患者合并为一组称为嗜睡组，昏迷患者为另一组；血管再通情况根据“心肌梗死溶栓后血管再通”(Thrombolysis inmyocardial infarction，TIMI)血流分级，TIMI评分0～1分定义为血管未通，2～3分为血管再通。 结果： 治疗后90ｄ单纯溶栓组、辅助机械再通组和对照组预后良好率分别为17.5%（10/57）、28.6%（8/28）和4%（2/50），死亡率分别为66.7%（38/57）、53.6%（15/28）和86%（43/50）。良好预后率方面单纯动脉溶栓组、辅助机械再通组明显优于对照组（p=0.03；p＜0.01）；死亡率方面单纯动脉溶栓组、辅助机械再通组亦明显低于对照组（p=0.03；p＜0.01）。介入手术结束前DSA造影，单纯动脉溶栓组血管再通率（TIMI2分以上）为43.8%，辅助机械再通组再通率为78.6%，两组再通率差异有统计学意义（p＜0.01）；术后90ｄ单纯溶栓与辅助机械再通组预后良好率、死亡率方面差异无统计学意义（p=0.26；p=0.27）。血管未通组预后良好率为7.9%（3/38），预后不佳为18.4%（7/38），死亡率为73.7%（28/38）；血管再通组预后良好率为31.9%（15/47），预后不佳率为14.9%（7/47），死亡率为53.2%（25/47）；介入治疗血管再通组患者预后好于未再通组，差异有统计学意义（p=0.01）。所有介入治疗组患者，发病6h内和6h以上两组的良好预后(mRS0～2)患者比率分别为25.7%（9/35）、18.0%（9/50），差异无统计学意义（p=0.39）。嗜睡组与昏迷组的良好预后率分别为39.5%（15/38）、6.4%（3/47），差异无统计学意义（p＜0.01）。单纯溶栓并发脑出血4例，其中2例为症状性脑出血；辅助机械再通组无脑出血病例。 结论： 单纯动脉溶栓、辅助机械再通均能明显提高因VBO导致后循环急性脑梗死患者的良好预后率，降低死亡率；辅助机械再通可以提高VBO的血管再通率，可能改善单纯动脉溶栓治疗效果不佳患者的预后；VBO患者手术时意识状态与患者远期预后密切相关；VBO患者死亡的最主要原因是脑梗死及其临床并发症。
[Abstract]:Objective:The effect and complications of arterial thrombolysis and mechanical recanalization in the treatment of posterior circulatory cerebral infarction caused by acute VBO were studied.Materials and methods:85 patients with acute cerebral infarction caused by VBO in recent 5 years were analyzed retrospectively. Among them, 57 cases were treated with arterial thrombolytic therapy and 28 cases were treated with auxiliary mechanical recanalization.Fifty patients with acute cerebral infarction caused by VBO in the same period were selected as control group.The age of the patients, the time from onset to treatment, the recanalization of blood vessels and the clinical prognosis of 90 days were collected and analyzed statistically.The clinical results of the intervention group were evaluated 90 days after operation (the control group was treated 90 days after the onset of the disease). According to the modified Rank score, the modified Rankin scale scale / mRS0 / 2 was classified as good prognosis and 3 / 5 as poor and 6 as death;In the interventional treatment group, the conscious and sleepy patients were combined into one group called somnolence group, and the coma patients were the other group.According to the blood flow grading and TIMI score 0 ~ 1 of Thrombolysis inmyocardial infarction after thrombolytic thrombolytic revascularization after myocardial infarction, vascular recanalization was divided into two groups.Results:90 days after treatment, the prognosis of the thrombolytic alone group, the adjuvant mechanical recanalization group and the control group were 17.5 / 57 / 28.6 / 28) and 4 / 2 / 50 / 28, respectively. The mortality rates were 66.7 / 57 / 53.6 / 1528% and 8643 / 50 / 50, respectively, in the thrombolytic alone group, the adjuvant mechanical recanalization group and the control group.In terms of good prognosis, the adjuvant mechanical recanalization group was significantly better than the control group (P < 0.01), and the mortality of the simple arterial thrombolytic group was significantly lower than that of the control group (P < 0.01), and the mortality of the simple arterial thrombolytic group was significantly lower than that of the control group (P < 0.01).Before the end of interventional operation, DSA angiography showed that the recanalization rate and TIMI2 score of pure thrombolytic group were 43.8and 78.6, respectively. The difference between the two groups was statistically significant (p < 0.01), and the prognosis of simple thrombolytic thrombolysis group and adjuvant mechanical recanalization group was good 90 days after operation.There was no significant difference in mortality between 0.26 and 0.27.琛，

本文编号：1703261