支架取栓治疗静脉溶栓禁忌症的急性缺血性脑卒中患者的对照研究

发布时间：2018-07-23 14:27

【摘要】：目的:静脉溶栓治疗已经成为在4.5小时时间窗内发病的急性缺血性脑卒中患者的标准治疗措施。然而,大部分患者因为各种禁忌症而不适宜静脉溶栓治疗。目前已有证据证明机械取栓合并静脉溶栓可以使合并大血管闭塞的患者获益。本文旨在通过神经科量表,分析单纯支架取栓患者和药物治疗患者的有效性,安全性,从而探索单纯支架取栓治疗对于存在静脉溶栓禁忌的急性缺血性脑卒中患者的应用价值。方法:选取2016年1月至2017年1月在山西省人民医院,太原市中心医院及解放军264医院就诊的急性缺血性脑卒中患者,纳入标准包括大动脉闭塞,存在静脉溶栓禁忌,发病时间在6小时内等,给予支架取栓治疗或药物治疗,治疗前后给予神经科量表评定,包括改良Rankin量表(mRS),美国国立卫生研究院卒中量表(NIHSS),对治疗前后相关量表评分,及治疗后血管再通率,并发症,死亡率,症状性颅内出血率等进行分析。结果:本研究共纳入了43名患者,其中23名患者接受了支架取栓治疗,20名患者接受了常规药物治疗。相对于常规药物治疗组,取栓组患者更年轻(58.70±13.23 vs69.2±11.54,P=0.009),女性更多(65.22%vs 30%,P=0.021)。取栓组患者闭塞部位包括颈总动脉闭塞1例,颈内动脉闭塞6例,大脑中动脉M1段闭塞12例,大脑中动脉M2段闭塞2例。椎动脉和基底动脉闭塞各1例。治疗后72小时平均NIHSS评分,取栓组为10(8.5),低于常规药物治疗组(P=0.043),也低于取栓组治疗前评分(P0.0001)。取栓组中患者治疗后90天mRS评分0-2级的率更高(47.83%vs 5%,P=0.002)。取栓组血管再通率(脑梗死溶栓系统等级评分2b/3级)明显升高(86.96%vs 5%,P=0.001)。两组患者在死亡率(8.7%vs15%,P=0.52)和症状性颅内出血率(0%vs15%,P=0.054)上无统计学差异。结论:1.对大动脉闭塞且有静脉溶栓禁忌的患者进行支架取栓治疗,可改善患者3天内的NIHSS评分,提升患者的神经功能恢复。2.对大动脉闭塞且有静脉溶栓禁忌的患者进行支架取栓治疗,可改善患者90天的mRS评分,改善患者功能独立性。3.对大动脉闭塞且有静脉溶栓禁忌的患者进行支架取栓治疗,不能降低患者90天的死亡率和症状性颅内出血率。
[Abstract]:Objective: intravenous thrombolytic therapy has become the standard treatment for acute ischemic stroke in 4.5 hours window. However, most patients are not suitable for intravenous thrombolysis because of various contraindications. There is evidence that mechanical thrombolysis combined with intravenous thrombolysis can benefit patients with macrovascular occlusion. The purpose of this study was to analyze the efficacy and safety of stenting alone and drug therapy in patients with acute ischemic stroke with venous thrombolytic taboos by neurologic scale, and to explore the application value of stenting alone in patients with acute ischemic stroke with venous thrombolytic taboos. Methods: patients with acute ischemic stroke were selected from January 2016 to January 2017 in Shanxi Provincial people's Hospital, Taiyuan City Hospital and PLA 264 Hospital. The included criteria included large artery occlusion and contraindication of venous thrombolysis. The onset time was within 6 hours. Stent thrombus removal or drug therapy was given before and after treatment. The neurology scale was evaluated before and after treatment, including the modified Rankin scale, (mRS), the stroke scale of the National Institutes of Health, (NIHSS), and the scores of the related scales before and after treatment. The rate of revascularization, complications, mortality and symptomatic intracranial hemorrhage were analyzed. Results: a total of 43 patients were enrolled in this study, of which 23 received stent thrombectomy and 20 received routine drug therapy. Compared with the routine drug group, the patients in the thrombectomy group were younger (58.70 卤13.23 vs69.2 卤11.54 vs69.2 卤0.009) and more in the female group (65.22%vs 30 + P0. 021). In the thrombectomy group, common carotid artery occlusion was found in 1 case, internal carotid artery occlusion in 6 cases, middle cerebral artery M1 segment occlusion in 12 cases and middle cerebral artery M2 segment occlusion in 2 cases. Vertebral artery occlusion and basilar artery occlusion in 1 case. The average NIHSS score at 72 hours after treatment was 10 (8.5) in the thrombectomy group, lower than that in the routine drug treatment group (P0. 043) and lower than that in the thrombectomy group (P0. 0001). In the thrombectomy group, the rate of 0-2 mRS score was higher 90 days after treatment (47.83%vs 5 and P0. 002). The recanalization rate (2b/3 grade of thrombolytic system grade of cerebral infarction) in the thrombolysis group was significantly higher (86.96%vs 5 / P0. 001). There was no significant difference in mortality (8.7 vs 15) and symptomatic intracranial hemorrhage (0 vs 15) between the two groups. Conclusion 1. Stent thrombolysis for patients with arterial occlusion and contraindication of venous thrombolytic therapy can improve the NIHSS score and improve the recovery of nerve function of the patients within 3 days. Stent removal for patients with arterial occlusion and contraindication of venous thrombolysis can improve the mRS score of 90 days and improve functional independence of the patients. Stent thrombolysis for patients with arterial occlusion and contraindication of venous thrombolysis could not reduce the death rate and symptomatic intracranial hemorrhage rate in 90 days.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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