应用介入血运重建技术治疗超早期急性脑梗死的临床分析

发布时间：2018-01-19 14:14

本文关键词： 急性脑梗死介入血运重建临床疗效和安全性　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的观察我院超早期急性脑梗死介入血运重建的临床疗效及其安全性;观察我院超早期急性脑梗死血运重建的救治绿色通道的运行情况;为我院进一步提高超早期急性脑梗死介入血运重建的临床疗效及其安全性和救治绿色通道的质量改进提供依据。方法回顾性分析2015年11月到2016年11月我院11例行超早期急性脑梗死介入血运重建患者的一般临床资料、发病到血管再通的各个环节所用时间、血管闭塞的部位、术后即刻mTICI血流分级和颅脑CT、术后影像学检查(颅脑CT、CTA、MRI、MRA)、术前和术后各个时间点(术后即刻、术后24h、术后3天、术后1周、术后2周、术后3个月)NIHSS评分,对我院超早期急性脑梗死介入血运重建救治的各个环节所用时间和脑卒中绿色通道流程的时间管理目标以及超早期急性脑梗塞介入血运重建的临床疗效及其安全性进行分析。结果我院介入血运重建患者与脑卒中绿色通道流程的时间管理目标相比就诊到完成颅脑CT检查的时间达标比率为22.2%,就诊到静脉溶栓开始时间均未达标,就诊到动脉置鞘时间达标比率为36.4%,动脉置鞘到开始动脉取栓或溶栓时间均达标,动脉置鞘到闭塞血管再通时间均达标;血管再通情况用mTICI血流分级评价,再通成功率为72.7%;症状性颅内出血率为37.5%;术前、术后即刻、术后24h、术后3天、术后1周、术后2周、术后3个月的NIHSS评分呈下降趋势,且配对t检验显示术后各组分别与术前相比差异均有统计学意义(p0.05);术后90d神经功能预后用mRS评分评价,预后良好率为62.5%,预后较差率为12.5%,死亡率为25%;血管再通成功的患者预后良好率为62.5%,预后较差率为12.5%,死亡率为25%,再通不成功患者中无预后良好患者,预后较差率为33.3%,死亡率为66.7%;8例血管再通成功的患者中有4例术后完善CTA或MRA检查,均无血管再闭塞。结论1.我院目前脑卒中绿色通道运行中在动脉置鞘到开始取栓、动脉置鞘到闭塞血管再通时间达到脑卒中绿色通道流程的时间管理目标;2.我院临床应用介入血运重建技术治疗超早期急性脑梗死初步总结是安全的、有效的;3.我院临床应用介入血运重建技术可以提高大动脉闭塞的血管再通率,血管再通成功的患者临床预后越好。
[Abstract]:Objective to observe the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction in our hospital. To observe the operation of green channel in the treatment of acute cerebral infarction in our hospital. To provide the basis for further improving the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction and the improvement of the quality of the treatment of green channels. Methods retrospective analysis was made from November 2015 to 2016. In November, 11 patients with super-early acute cerebral infarction underwent interventional revascularization. The time to recanalization, the location of occlusion, the mTICI blood flow grading and craniocerebral CTS immediately after operation, and the imaging examination after operation. NIHSS scores were obtained at all time points before and after operation (immediate, 24 hours, 3 days, 1 week, 2 weeks and 3 months after operation). The objective of time management for the treatment of each link of interventional revascularization of ultra-early acute cerebral infarction and the time management of green channel flow of stroke, and the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction in our hospital. Results compared with the time management target of green channel process of stroke, the ratio of time to complete CT examination in patients with interventional revascularization in our hospital was 22.2%. The starting time of venous thrombolytic therapy was not up to the standard. The rate of reaching the standard of arterial sheath insertion time was 36.4%, and the time from arterial sheath placement to beginning artery thrombolysis or thrombolysis was up to standard. The recanalization time of artery sheath to occlusive vessel was up to standard. The vascular recanalization was evaluated by mTICI blood flow grading. The successful rate of recanalization was 72.7%. The rate of symptomatic intracranial hemorrhage was 37.5%. Before, immediately after operation, 24 hours after operation, 3 days after operation, 1 week after operation, 2 weeks after operation, and 3 months after operation, the NIHSS score showed a downward trend. The paired t test showed that there were significant differences between the groups after operation and those before operation (P 0.05). 90 days after operation, the prognosis of nerve function was evaluated by mRS score. The good prognosis rate was 62.5%, the poor prognosis rate was 12.5%, and the mortality rate was 25.5%. The good prognosis rate was 62.5%, the poor prognosis rate was 12.5%, and the mortality rate was 25% in the patients with successful recanalization. The poor prognosis rate was 33.3% in the patients with unsuccessful recanalization. The mortality rate was 66.7; Of the 8 patients with successful revascularization, 4 had improved CTA or MRA examination after operation, and none of them were re-occluded. Conclusion 1. At present, during the operation of green channel of stroke in our hospital, the artery sheath is placed to begin to take thrombus. 2. The time of recanalization from artery sheath to occluded vessel reached the goal of time management of green channel flow in stroke. 2. It is safe and effective to apply interventional revascularization technique in the treatment of ultra-early acute cerebral infarction in our hospital. 3. The clinical application of interventional revascularization in our hospital can improve the recanalization rate of large artery occlusion, and the better the prognosis of the patients with successful revascularization.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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