静脉溶栓桥接动脉内取栓治疗颅内大血管急性闭塞的效果分析

发布时间：2018-03-13 03:06

  本文选题：颅内大血管急性闭塞　切入点：静脉溶栓　出处：《中国脑血管病杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨静脉溶栓桥接动脉内取栓开通颅内大血管急性闭塞的安全性和有效性。方法回顾性分析首都医科大学宣武医院2016年1月至9月采用静脉溶栓桥接动脉内取栓模式治疗的63例颅内大血管急性闭塞患者的临床资料,静脉溶栓开始时间在发病≤4.5 h,血管内治疗开始时间(股动脉穿刺)在发病≤6 h。根据取栓方式将其分为单纯支架取栓组(41例)和支架联合抽吸取栓组(22例),两组患者在性别构成、平均年龄、闭塞部位及入院美国国立卫生研究院卒中量表(NIHSS)评分方面差异无统计学意义(均P0.05)。采用改良脑梗死溶栓试验(m TICI)评价血管开通效果,分析静脉桥接下两种动脉内治疗方式的血管再通时间,取栓次数,入院时、术后72 h和90 d的NIHSS评分,术中及术后并发症发生情况。结果 (1)单纯支架取栓组中,前循环闭塞37例(90.2%),后循环闭塞4例(9.8%);支架联合抽吸取栓组中,前循环闭塞20例(90.9%),后循环闭塞2例(9.1%),组间差异无统计学意义(P0.05)。治疗后患者大血管均获得良好开通(m TICI分级:Ⅱb~Ⅲ级)。(2)单纯支架取栓组血管平均再通时间为(86±11)min,平均动脉取栓次数为(2.8±0.9)次;术后并发症发生率为14.6%(症状性出血5例,心源性死亡1例),90 d随访mRS(0~2分)患者占51.2%(21/41)。支架联合抽吸取栓组血管平均再通时间为(83±11)min,平均动脉取栓次数为(2.2±0.8)次,术后并发症发生率为13.6%(症状性出血2例,心源性死亡1例),90 d随访mRS(0~2分)患者占59.1%(13/22)。两组以上指标比较,差异均有统计学意义(均P0.05)。结论静脉溶栓桥接单纯支架取栓和支架联合抽吸取栓均能快速使颅内闭塞大血管获得再通,并且支架联合抽吸取栓具有更好的再通率。但两种技术在改善患者临床预后方面尚有待进一步研究。
[Abstract]:Objective to investigate the safety and efficacy of intravenous thrombolytic bridging arterial thrombolysis in the treatment of acute intracranial large vessel occlusion. Methods from January 2016 to September, Xuanwu Hospital, Capital University of Medical Sciences, was retrospectively analyzed. Clinical data of 63 patients with acute intracranial macrovascular occlusion treated by thrombectomy. The onset time of venous thrombolysis was less than 4.5 h, and that of intravascular therapy was less than 6 h. According to the method of thrombolysis, the thrombolysis was divided into two groups: 41 cases in the stenting group and 22 cases in the combined stent extraction group, both of which were divided into two groups: stenting alone group (n = 41) and stent combined extraction group (n = 22). Group A patients in the gender composition, There was no significant difference in mean age, occlusion site and NIHSS score (all P 0.05). Modified thrombolytic test (mTICI) was used to evaluate the effect of vascular patency. The recanalization time, the times of thrombus removal, the NIHSS score of 72 h and 90 d after admission, the complications during and after operation were analyzed. 37 cases of anterior circulatory occlusion and 4 cases of posterior circulation occlusion were treated with anterior circulation occlusion (37 cases) and posterior circulation occlusion group (4 cases). 20 cases with anterior circulation occlusion and 2 cases with posterior circulation occlusion had no significant difference between the two groups (P 0.05). After treatment, the major vessels of all the patients were well opened m TICI grade: 鈪，

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