颅内外重度动脉狭窄患者药物治疗与血管内支架植入治疗卒中复发评估
发布时间：2018-08-08 16:00
【摘要】：目的:探讨河北沧州地区颅内外重度动脉狭窄患者药物治疗与血管内支架植入术治疗卒中复发的差异,以期寻找沧州地区颅内外重度动脉狭窄患者的卒中最佳治疗方法。方法:1研究对象选择选取2007年6月-2013年6月800例河北省沧州市人民医院颅内外动脉狭窄(70-99%)的患者,符合1995年全国脑血管会议制定的脑卒中标准。分为药物治疗组和血管内支架植入组,两组在性别、年龄、高血压、高脂血症、糖尿病、吸烟史脑血管病危险因素上差异无统计学差异。2治疗方法①药物治疗组:按照缺血性脑卒中二级预防指南,积极控制患者危险因素,给予拜阿司匹林100mg/d、硫酸氢氯吡格雷75mg/d;联合应用3月后,改为拜阿司匹林100mg/d;②动脉支架植入组:按照正确动脉支架植入操作方法,释放支架,解脱支架后,支架内残余狭窄率小于30%,血流正向流动顺畅,提示支架释放成功。对于狭窄大于30%病人需再次进行球囊后扩张,全麻患者清醒后再次对患者进行神经系统功能检查;术后应用药物治疗:给予拜阿司匹林100mg/d、硫酸氢氯吡格雷75mg/d;双抗联合应用3月后,改为拜阿司匹林100mg/d长期使用。3观察方法患者出院后第1年、第2年,进行头、颈CTA或DSA复检,比较血管的狭窄情况,行头MRI了解是否存在新的卒中发生,记录责任血管闭塞、再狭窄情况及短暂性脑缺血发作、脑梗死的发生情况,应用NIHSS评分进行神经系统综合的评定。结果:对两种治疗方法卒中复发情况和神经功能评定进行比较,随访1年,药物组新发卒中生率为23.08%,狭窄血管供血区卒中占18.9%,死亡率5.7%,而血管内支架植入治疗组新发卒中发生率为17.0%,狭窄血管供血区卒中占10.24%,死亡率3.07%,两者比较差异有统计学意义(P0.05);随访2年,药物组新发卒中生率为38.1%,狭窄血管供血区卒中占30.44%,死亡率8.65%,而血管内支架植入治疗组新发卒中发生率为26.6%,狭窄血管供血区卒中占14.95%,死亡率4.91%,两者比较差异有统计学意义(P0.05);血管内支架植入组在出院后1年、2年的NIHSS评分均优于药物治疗组,两者存在显著差异(P0.05)。结论:针对重度颅内外动脉狭窄患者,血管内支架植入在患者出院后1年、2年的随访中,新发缺血性卒中发生率、患者死亡率,平均NIHSS评分方面经统计学处理后均优于药物治疗组。在河北沧州地区,对重度颅内外动脉狭窄患者行血管内支架植入术治疗,对预防脑血管病复发有效。
[Abstract]:Objective: to explore the difference between drug therapy and endovascular stent implantation in the treatment of stroke recurrence in patients with severe extracranial and extracranial arterial stenosis in Cangzhou, Hebei Province, in order to find the best treatment method for stroke in patients with severe intracranial and extracranial artery stenosis. Methods from June 2007 to June 2013, 800 patients with intracranial and external artery stenosis (70-99%) in Cangzhou people's Hospital of Hebei Province were selected. They were divided into two groups: drug therapy group and intravascular stent implantation group. The two groups were divided into two groups: sex, age, hypertension, hyperlipidemia, diabetes mellitus. There was no significant difference in risk factors of cerebrovascular diseases in smoking history. 2 treatment methods 1 Drug treatment group: according to the secondary prevention guidelines of ischemic stroke, the risk factors of patients were actively controlled. Give aspirin 100 mg / d, hydrogen clopidogrel sulfate 75 mg / d; after 3 months of combined use, change to aspirin 100 mg / d 2 arterial stent implantation group: according to the correct method of arterial stent implantation, release the stent, release the stent, The residual stenosis rate was less than 30%, and the flow of blood was smooth, indicating that stent release was successful. For the patients with stenosis more than 30%, the patients should be dilated again after balloon dilatation, and the patients with general anesthesia should be examined again for nervous system function after waking up. Postoperative drug therapy: aspirin 100 mg / d, hydroclopidogrel sulfate 75 mg / d, double antibody combined therapy 3 months later, patients with long-term use of Aspirin 100mg/d 3 years after discharge, second year, head, neck CTA or DSA were re-examined, and the patients were treated with Aspirin 100 mg / d and clopidogrel sulfate 75 mg / d, respectively. To compare the stenosis of blood vessels, MRI was used to evaluate the occurrence of new stroke, to record the occlusion of responsible vessels, restenosis, transient ischemic attack and cerebral infarction, and to evaluate the nervous system by NIHSS score. Results: the recurrence of stroke and the evaluation of neurological function were compared between the two methods. The patients were followed up for 1 year. The incidence of new stroke was 23.08 in the drug group, 18.9 in the narrow blood supply area, and 5.7in the intravascular stent implantation group. The incidence of new stroke was 17.0 in the stent implantation group, 10.244in the narrow blood supply area, and 3.07 in the drug group. There was a statistical difference between the two groups. Academic significance (P0.05); follow up for 2 years, The rate of new stroke in the drug group was 38.1%, the rate of stroke in the narrow blood supply area was 30.44 and the mortality was 8.65. In the treatment group, the incidence of new stroke was 26.6. the incidence of stroke in the narrow blood supply area was 14.95 and the mortality rate was 4.91. The difference between the two groups was statistically significant. The NIHSS scores in the endovascular stent implantation group were better than those in the drug treatment group in 1 year and 2 years after discharge (P0.05). There was significant difference between them (P0.05). Conclusion: for the patients with severe intracranial and external artery stenosis, the incidence of new ischemic stroke and the mortality of the patients were observed during the follow-up of 1 year and 2 years after discharge. The average NIHSS score was better than that in the drug treatment group after statistical treatment. In Cangzhou area of Hebei Province, endovascular stent implantation is effective in preventing the recurrence of cerebrovascular disease in patients with severe intracranial and external artery stenosis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3
本文编号：2172294
[Abstract]:Objective: to explore the difference between drug therapy and endovascular stent implantation in the treatment of stroke recurrence in patients with severe extracranial and extracranial arterial stenosis in Cangzhou, Hebei Province, in order to find the best treatment method for stroke in patients with severe intracranial and extracranial artery stenosis. Methods from June 2007 to June 2013, 800 patients with intracranial and external artery stenosis (70-99%) in Cangzhou people's Hospital of Hebei Province were selected. They were divided into two groups: drug therapy group and intravascular stent implantation group. The two groups were divided into two groups: sex, age, hypertension, hyperlipidemia, diabetes mellitus. There was no significant difference in risk factors of cerebrovascular diseases in smoking history. 2 treatment methods 1 Drug treatment group: according to the secondary prevention guidelines of ischemic stroke, the risk factors of patients were actively controlled. Give aspirin 100 mg / d, hydrogen clopidogrel sulfate 75 mg / d; after 3 months of combined use, change to aspirin 100 mg / d 2 arterial stent implantation group: according to the correct method of arterial stent implantation, release the stent, release the stent, The residual stenosis rate was less than 30%, and the flow of blood was smooth, indicating that stent release was successful. For the patients with stenosis more than 30%, the patients should be dilated again after balloon dilatation, and the patients with general anesthesia should be examined again for nervous system function after waking up. Postoperative drug therapy: aspirin 100 mg / d, hydroclopidogrel sulfate 75 mg / d, double antibody combined therapy 3 months later, patients with long-term use of Aspirin 100mg/d 3 years after discharge, second year, head, neck CTA or DSA were re-examined, and the patients were treated with Aspirin 100 mg / d and clopidogrel sulfate 75 mg / d, respectively. To compare the stenosis of blood vessels, MRI was used to evaluate the occurrence of new stroke, to record the occlusion of responsible vessels, restenosis, transient ischemic attack and cerebral infarction, and to evaluate the nervous system by NIHSS score. Results: the recurrence of stroke and the evaluation of neurological function were compared between the two methods. The patients were followed up for 1 year. The incidence of new stroke was 23.08 in the drug group, 18.9 in the narrow blood supply area, and 5.7in the intravascular stent implantation group. The incidence of new stroke was 17.0 in the stent implantation group, 10.244in the narrow blood supply area, and 3.07 in the drug group. There was a statistical difference between the two groups. Academic significance (P0.05); follow up for 2 years, The rate of new stroke in the drug group was 38.1%, the rate of stroke in the narrow blood supply area was 30.44 and the mortality was 8.65. In the treatment group, the incidence of new stroke was 26.6. the incidence of stroke in the narrow blood supply area was 14.95 and the mortality rate was 4.91. The difference between the two groups was statistically significant. The NIHSS scores in the endovascular stent implantation group were better than those in the drug treatment group in 1 year and 2 years after discharge (P0.05). There was significant difference between them (P0.05). Conclusion: for the patients with severe intracranial and external artery stenosis, the incidence of new ischemic stroke and the mortality of the patients were observed during the follow-up of 1 year and 2 years after discharge. The average NIHSS score was better than that in the drug treatment group after statistical treatment. In Cangzhou area of Hebei Province, endovascular stent implantation is effective in preventing the recurrence of cerebrovascular disease in patients with severe intracranial and external artery stenosis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3
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