支架机械取栓治疗急性大脑中动脉栓塞的临床疗效与长期预后观察

发布时间：2018-07-10 03:48

本文选题：支架取栓 + 动脉溶栓　；参考：《山东医药》2017年46期

【摘要】：目的探讨支架机械取栓治疗急性大脑中动脉栓塞的临床疗效。方法 116例急性大脑中动脉栓塞患者按照治疗方式分为动脉溶栓组51例和支架取栓组65例。动脉溶栓组给予选择性动脉溶栓治疗,支架取栓组给予Solitaire支架进行机械取栓治疗。手术结束前采用脑梗死溶栓试验(TICI)分级评价血管再通情况,治疗前及治疗后7 d行美国国立卫生研究院卒中量表(NIHSS)评分判定临床疗效。术后24 h行颅脑CT检查,并观察皮肤、消化道出血情况,明确是否存在颅内及其他部位出血。术后90、180 d采用改良Rankin量表(mRS)评分评估患者预后。结果支架取栓组、动脉溶栓组血管再通率分别为96.9%(63/65)、76.5%(39/51),支架取栓组血管再通率高于动脉溶栓组(P0.05)。支架取栓组总有效率高于动脉溶栓组(P0.05)。支架取栓组在治疗过程中无不良事件发生,动脉溶栓组出现黑便1例,两组出血发生率差异无统计学意义(P0.05)。支架取栓组术后90、180 d时mRS评分均低于动脉溶栓组(P均0.05)。结论支架机械取栓治疗具有较高的血管再通率,可显著改善急性大脑中动脉栓塞患者的临床疗效和长期预后,且不增加不良反应的发生率。
[Abstract]:Objective to investigate the clinical effect of stent mechanical embolization in the treatment of acute middle cerebral artery embolism. Methods 116 patients with acute middle cerebral artery embolism were divided into thrombolytic group (51 cases) and stenting group (65 cases). Selective arterial thrombolytic therapy was performed in the arterial thrombolysis group and mechanical thrombolysis was performed in the stent removal group. Cerebral infarction thrombolytic test (TICI) was used to evaluate the recanalization of blood vessels before and 7 days after the operation, and the National Institutes of Health Stroke scale (NIHSS) was used to evaluate the clinical efficacy. Craniocerebral CT was performed 24 hours after operation, and the bleeding of skin and digestive tract was observed. The prognosis was evaluated by modified Rankin scale (Mrs) 90180 days after operation. Results the recanalization rate of artery thrombolytic group was 96.9% (63 / 65) and 76.5% (39 / 51) respectively. The recanalization rate of stent removal group was higher than that of arterial thrombolytic group (P0.05). The total effective rate of stenting group was higher than that of arterial thrombolysis group (P0.05). There were no adverse events in the stenting group and 1 case in the arterial thrombolysis group. There was no significant difference in the incidence of bleeding between the two groups (P0.05). The Mrs score of stent removal group was lower than that of arterial thrombolytic group at 90180 days postoperatively (P 0.05). Conclusion the stent mechanical thrombectomy has a high vascular recanalization rate and can significantly improve the clinical efficacy and long-term prognosis of patients with acute middle cerebral artery embolism without increasing the incidence of adverse reactions.
【作者单位】：天津中医药大学第二附属医院;
【分类号】：R743.33

【相似文献】