伴有心房纤维性颤动的急性缺血性卒中患者机械取栓治疗的疗效观察  

The therapeutic effect and prognosis of acute cerebral infarction patients with atrial fibrillation treated by interventional thrombectomy

作　　者：潘晓华[1] 刘国荣[1] 刘秀珍[1] 崇奕[1] 梁芙茹[1] 张晖[1] 姜长春[1] 张天佑[1] 

机构地区：[1]包头市中心医院神经内科,内蒙古014040

出　　处：《脑与神经疾病杂志》2017年第10期636-641,共6页Journal of Brain and Nervous Diseases

基　　金：2015年包头市社会发展科技支撑项目(2015S4-1-8)

摘　　要：目的探讨伴有心房纤维性颤动(AF)的急性缺血性卒中患者行机械取栓治疗的有效性和安全性。方法此研究包含从2011年1月1日至2016年2月29日在包头市中心医院神经内科住院的77例计划进行机械取栓术治疗的急性缺血性卒中患者,通过动态心电图监测对患者判定分组。其中20例归为AF组而另外57例为非AF组。机械取栓术前,先使用美国国立卫生研究院卒中量表(NIHSS)对患者评分。取栓后即刻通过脑血管造影观察血管再通情况和残余狭窄情况,并且分别在术后即刻,24h和72h后对患者使用NIHSS标准评分。手术三个月后使用改良的Rankin评分标准(m RS)对患者进行卒中后残疾评分。使用Logistic回归分析找出影响结果的因素。结果急性缺血性卒中行机械取栓术治疗的患者,血管再通率AF组为95%和非AF组的98.25%之间没有明显差别(P=0.455),而闭塞血管的残余狭窄率AF组为0%明显低于非AF组的50%(P=0.001),取栓后进一步行二线血栓切除术(包括:动脉溶栓术、球囊扩张术、支架置入术等)治疗后,闭塞血管的残余狭窄率AF组为0%仍明显低于非AF组的5%(P=0.015)。NIHSS评分组间没有显著差异(P>0.05),m RS评分显示相似比例的预后良好(P>0.05)。回归分析表明,在对年龄、性别、体质量、血压和潜在的疾病调整后,AF组取栓后有较低的残余狭窄率(P=0.004,OR=1.293[1.086,1.540])。结论尽管急性缺血性卒中患者无论是否具有AF都受益于机械取栓术,AF可以提示术后闭塞血管的残余狭窄率较低。Objective To investigate the efficacy and safety of interventional thrombectomy in acute cerebral infarction patients with atrial fibrillation （ AF ） . AF is a prognostic predictor for patients with ischemic stroke undergoing thrombeetomy. Method Seventy-seven cases with isehemie stroke and indicated for thrombectomy were enrolled between January 1,2011 and February 29, 2016. Hoher monitoring was used to identify AF. Subsequently 20 cases and 57 cases were classified into the AF and the non-AF group, respectively. Before thrombectomy, the National Institutes of Health Stroke Scale （ NIHSS ） score was obtained. After thrombectomy, coronary angiography observed recanalization and restenosis; NIHSS score was obtained immediately and 24 h and 72 h following surgery; the modified Rankin Scale （ mRS ） score was obtained 3 months after surgery to assess poststroke residual disability. Logistic regression analysis was performed to identify the factors affecting outcome. Results The residual stenosis rate was significantly lower in the AF group than non-AF group treated by thrombectomy （ 0% vs 50% ） （ P=0.001 ） and second-line thrombectomy （ 0% vs 5% ） （ P=0.015 ） . NIHSS score was not significantly different between the groups （ P〉0.05 ） and mRS score indicated similar percentages of good prognosis （ P〉0.05 ） . Regression analysis showed that after adjusting age, sex, weight, blood pressure and underlying diseases, the AF group had lower residual stenosis rates （P=0.004,OR=1.293 [ 1.086,1.540 ]）. Conclusion Although isehemic stroke patients may benefit from thrombectomy regardless of AF, AF predicts a lower stenosis rate after surgery.

关 键 词：缺血性卒中 心房纤维性颤动(房颤) 机械取栓术 血管再通率 狭窄率 

分 类 号：R743.32[医药卫生—神经病学与精神病学]