血管内再通结合短时间极低温生理盐水颈动脉灌注治疗大脑中动脉急性闭塞的对照研究  

Endovascular recanalization combined with intra-carotid short-time extreme low temperature normal saline infusion for acute MCAO

作　　者：万跃[1] 彭小祥[1] 刘文军[1] 但毕堂[1] 严丹[1] 朱遂强[2] 

机构地区：[1]武汉大学附属中山医院神经内科脑血管病介入治疗中心,430030 [2]华中科技大学附属同济医院神经内科

出　　处：《中华老年心脑血管病杂志》2015年第10期1061-1064,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：武汉市中青年医学骨干人才(2014-41)

摘　　要：目的比较大脑中动脉急性闭塞行血管内再通与血管内再通结合短时间极低温生理盐水颈动脉灌注2种治疗方法的安全性和效果。方法选择大脑中动脉急性闭塞患者20例,根据入选标准及患者家属意愿分为常规治疗组4例、常温组8例(单纯血管内再通治疗)和低温组8例(血管内再通结合短时间极低温生理盐水颈动脉灌注治疗)。对比分析各组患者手术前后各项指标(体温、心率、血压、红细胞压积及血小板计数)和术前、术后1、7、15d患者美国国立卫生研究院卒中量表评分动态变化及发病24h梗死体积。结果 3组不同时间点各项指标无明显变化,临床上未有不良反应发生。低温组术后1、7、14d神经功能缺损评分较常规治疗组和常温组明显降低,低温组发病24h梗死体积[(6.41±3.28)cm3 vs(13.65±5.27)cm3,(9.15±4.12)cm3]较常规治疗组和常温组明显减小,差异有统计学意义(P<0.05)。结论血管内再通结合短时间极低温生理盐水颈动脉灌注是一种安全的治疗手段,比单纯血管内再通治疗大脑中动脉急性闭塞在术后的神经功能缺损评分和梗死体积均有明显改善。Objective To compare the safety and efficacy of endovascular recanalization combined with intra-carotid short-time extreme low temperature normal saline infusion for acute MCAO.Methods Twenty patients were divided into conventional treatment group（group A,n=4）,simple endovascular revascularization combined with normal temperature saline infusion group（group B,n=8）,and endovascular revascularization combined with intra-carotid short-time extreme low temperature normal saline infusion group（group C,n=8）.Their temperature,heart rate,blood pressure,MCV,PLT count before operation,NIHSS score on days 1,7,15 after operation,and infarction size 24 hafter onset of acute MCAO were comparatively analyzed.Results No significant change was found in different clinical parameters at different time points between groups B and C with no occurrence of adverse reaction.The NIHSS score was significantly lower in group C than in groups A and B on days 1,7and 14 after operation.The infarction size was significantly smaller in group C than in groups A and B 24 hafter onset of acute MCAO（6.41±3.28cm3 vs 13.65±5.27cm3,6.41±3.28cm3 vs 9.15±4.12cm3,P〈0.05）.Conclusion The efficiency and safety of endovascular recanalization combined with intra-carotid short time extreme low temperature normal saline infusion are better than those of endovascular recanalization in improving the NHISS score and reducing the infarction size after acute MCAO.

关 键 词：梗死 大脑中动脉 低温 输注 动脉内 颈动脉 

分 类 号：R743.3[医药卫生—神经病学与精神病学]