支架取栓治疗静脉溶栓禁忌证的急性缺血性脑卒中患者的对照研究  

Stent retriever thrombectomy in patients with acute ischemic stroke contraindicated for intravenous thrombolysis:a comparative study

作　　者：柳青[1] 刘毅[2] 朱青峰[3] 李伟荣[1] 孙雅轩[2] 温超 苏暘力 李晓泽[1] 孙奇[3] 胡风云[2] 

机构地区：[1]太原市中心医院神经内科,030009 [2]山西省人民医院神经内科 [3]解放军第264医院神经外科

出　　处：《中国药物与临床》2018年第1期26-30,共5页Chinese Remedies & Clinics

摘　　要：目的本文旨在探索单纯支架取栓治疗对于存在静脉溶栓禁忌的急性缺血性脑卒中患者的应用价值。方法选取2016年1月至2017年1月在山西省人民医院,太原市中心医院及解放军264医院就诊的急性缺血性脑卒中患者,纳入标准包括大动脉闭塞,存在静脉溶栓禁忌,发病时间在6 h内等,给予支架取栓治疗或药物治疗,治疗前后给予神经科量表评定,包括改良Rankin量表(m RS),美国国立卫生研究院卒中量表(NIHSS),对治疗前后相关量表评分及治疗后血管再通率、并发症、病死率、症状性颅内出血率等进行分析。结果本研究共纳入了43例患者,其中23例患者接受了支架取栓治疗,20例患者接受了常规药物治疗。相对于常规药物治疗组,取栓组患者更年轻(59±13)岁和(69±12)岁,P=0.009,女性更多(65%和30%,P=0.021)。治疗后72 h平均NIHSS评分,取栓组为10(7,15.5),低于常规药物治疗组(P=0.043),也低于取栓组治疗前评分(P<0.01)。取栓组中患者治疗后90 d m RS评分0~2级的率更高(48%和5%,P=0.002),血管再通率(脑梗死溶栓系统等级评分2b/3级)明显升高(87%和5%,P=0.001)。2组患者在病死率(9%和15%,P=0.52)和症状性颅内出血率(0和15%,P=0.054)上差异无统计学意义。结论对大动脉闭塞且有静脉溶栓禁忌的患者进行支架取栓治疗,可改善患者3 d内的NIHSS评分,改善患者90 d的m RS评分,但不能降低患者90 d的病死率和症状性颅内出血率。Objective To investigate the value of simple stent retriever thrombectomy in patients with acute ischemic stroke contraindicated for intravenous thrombolysis.Methods Included in this study were acute ischemic stroke patients who visited Shanxi Provincial People′s Hospital,Taiyuan City Central Hospital and People′s Liberation Army No.264 Hospital between January 2016 and January 2017.The inclusion criteria were ：major artery occlusion,presence of indications against intravenous thrombolysis,and an onset time of 6 h.The patients were given stent retriever thrombectomy or conventional medications.Before and after treatment,neurological scale assessment were evaluated using the modified Rankin scale（m RS）,the National Institute of Health Stroke Scale（NIHSS）.Recanalization success,complications,mortality,and symptomatic intracranial hemorrhages were determined.Results A total of 43 patients were enrolled in this study,of which,23 patients underwent stent retriever thrombectomy and20 received conventional medications.More patients in the thrombectomy group were young（59±13 vs 69±12,P=0.009） and female（65% vs 30%,P=0.021） compared with those in the conventional medication group.The mean NIHSS score at 72 h after treatment was 10（7,15.5） in the thrombectomy group,which was lower than that in the conventional medication group（P=0.043） and also lower than baseline in the same group（P0.01）.Patients in the thrombectomy group had a significantly higher rate of m RS score 0-2 at 90 days（48% vs 5%,P=0.002） and a significantly higher revascularization rate（as reflected by thrombolysis in cerebral infarction grade 2 b/3）（87% vs 5%,P=0.001）.There were no significant differences between the two groups in mortality（9% vs 15%,P=0.52） and symptomatic intracranial hemorrhage（0 vs 15%,P =0.054）.Conclusion Stent retriever thrombectomy in patients with major artery occlusion but contraindicated for intravenous thrombolysis may improve the 3-day NIHSS score and90-day m RS score,but ma

关 键 词：支架取栓 静脉溶栓禁忌证 卒中 缺血性 急性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]