以机械取栓为主的动脉内多模式方法治疗急性大动脉闭塞性脑梗死的效果分析  

Effect analysis of multi-interventional modes mainly with mechanical thrombectomy for large artery occlusive acute cerebral infarction

作　　者：高宗恩[1] 陈晓辉[1] 陈健[2] 钟孟飞[1] 李海停[1] 杨志杰[1] 刘迎春[1] 张立功[1] 李海蓉[1] 吴德云[1] 

机构地区：[1]胜利油田中心医院神经内科,山东省东营市257000 [2]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2017年第2期71-76,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家科技支撑项目(2011BAI08B07)

摘　　要：目的探讨对急性大动脉闭塞性脑梗死患者接受以机械取栓为主的动脉内多模式方法治疗的有效性和安全性及其影响预后的相关因素。方法回顾性分析56例急性大动脉闭塞性脑梗死患者的临床资料,观察临床特点(性别、年龄、相关基础疾病)、治疗时机(发病至穿刺时间、穿刺至开通时间)、多模式治疗(动脉内溶栓、取栓、球囊扩张、支架置入等)、责任血管分布等项目。评估血管再通情况采用改良脑梗死溶栓试验(m TICI)分级,观察术前和术后24 h神经功能采用美国国立卫生研究院卒中量表(NIHSS)评分,采用改良Rankin量表(mRS)评价术后3个月预后。根据术后3个月预后情况将入组患者分为预后良好组(34例,mRS≤2分)和预后不良组(22例,mRS≥3分),行单因素分析,再进一步行多因素Logistic回归分析影响预后的因素。结果 (1)56例患者血管再通率为78.6%(44例),其中基底动脉最高,达93.8%(15/16),大脑中动脉87.0%(20/23)。治疗后24 h NIHSS评分(10±7)分,低于入院时的(16±6)分,差异有统计学意义(t=6.401,P<0.01)。3个月预后良好34例(60.7%),死亡4例(7.1%),症状性颅内出血8例(14.3%)。(2)多因素分析显示:血管再通级别高,是良好预后的保护因素(OR=0.465,95%CI:0.267~0.809,P=0.007);糖尿病是预后不良的独立危险因素(OR=5.535,95%CI:1.101~27.835,P=0.038)。结论急性大动脉闭塞性脑梗死动脉内多模式治疗能快速有效地恢复颅内血流,具有开通率高和预后好的特点。并且血管再通级别越高,预后越好。而糖尿病是预后不良的独立危险因素。Objective To investigate the effectiveness and safety in patients with largeartery occlusive acute cerebral infarction who received muhi-interventional modes mainly with mechanical thrombeetomy and its related factors affecting prognosis. Methods The clinical data of 56 patients with large artery occlusive acute cerebral infarction were analyzed retrospectively. The clinical characteristics （ gender, age, and underlying diseases） , timing of treatment （time from ictus to puncture, time from puncture to recanalization） , multi-interventional mode therapies （ intra-arterial thrombolysis, thrombectomy, balloon dilation, and stenting, etc. ） , and distribution of offending vessels were observed. The modified Thrombolysis in Cerebral Ischemia Scale （mTICI） grade was used to evaluate revascularization. The National Institute of Health Stroke Scale （NIHSS） score was used to observe the neurological function at 24 h before and after procedures. The modified Rankin scale （mRS） was used to evaluate the prognosis at 3 months after procedure. The safety of the treatment was evaluated with operative complications （mainly symptomatic intracranial hemorrhage ） and mortality. The patients were divided into either a good prognosis group （ n = 34 ; mRS ≤〈 2 ） or a poor prognosis group （n = 22 ;mRS ≥3 ） according to the prognosis at 3 mouths after procedure. They were analyzed with univariate analysis. Tile factors influencing the prognosis were further analyzed with multivariate logistic regression analysis. Results （ 1 ） The recanalization rate in 56 patients was 78.6% （ n = 44 ） , in which basilar artery was the highest,reaching 93.8% （15/16） ,middle cerebral artery was 87.0% （20/23）. The NIHSS score at 24 hours was 10 ± 7, it was lower than 16 ± 6 on admission. There was significant difference （ t = 6. 401, P 〈 0.01 ）. At 3 months,34 patients （60.7%） had good prognosis,4 （ 7.1% ） died, and 8 （ 14.3 % ） had symptomatic intracranial hemorrhage. （2）

关 键 词：脑梗死 大血管闭塞 机械取栓 多模式 

分 类 号：R743.33[医药卫生—神经病学与精神病学]