机械血栓切除术治疗心房颤动所致心源性栓塞性卒中的有效性和安全性：与单纯静脉溶栓的比较  

Efficacy and safety of mechanical thrombectomy for cardioembolic stroke due to atrial fibrillation： a comparison with intravenous thrombolysis alone

作　　者：刘春梅[1] 施洪超[1] 黄清[1] 候健康 周俊山[1] Liu Chunmei;Shi Hongchao;Huang Qing;Hou Jiankang;Zhou Junshan(Nanjing Hospital Affiliated to Nanjing Medical University （Nanjing First Hospital）, Nanjing 210006, China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)神经科

出　　处：《国际脑血管病杂志》2018年第3期161-166,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的 探讨机械血栓切除术治疗心房颤动所致心源性栓塞卒中（cardioembolic stroke,CES）的有效性和安全性.方法 回顾性纳入2015年1月至2017年9月收治的CES患者.按治疗方式将患者分为血栓切除和单纯静脉溶栓组,比较2组基线资料以及治疗后24 h美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分、发病后90 d时改良Rankin量表（modified Rankin Scale,mRS）评分判定的转归良好（0～2分）和转归不良（＞2分）以及出血性转化和死亡.应用多变量logistic回归分析确定CES患者转归的独立影响因素.结果 共纳入1 17例患者,其中血栓切除组65例（55.6％）,单纯静脉溶栓组52例（44.4％）;62例（53.0％）90 d转归良好,55例（47.0％）转归不良.血栓切除组治疗后24 h内NIHSS下降＞4分的患者比例（58.4％对26.9％;x2=6.254,P=0.007）、血管再通良好率（78.5％对57.7％;x2=5.850,P=0.016）和90 d时转归良好率（63.1％对40.4％;x2 =5.972,P=0.015）均显著高于单纯静脉溶栓组,而出血性转化、有症状脑出血和消化道出血发生率以及90 d病死率差异均无统计学意义.多变量logistic回归分析显示,血管再通良好[优势比（odds ratio,OR）0.371,95％可信区间（confidence interval,CI）0.157 ～0.876;P=0.024]和血栓切除术（OR 0.398,95％ CI0.179～0.883;P=0.024）为CES转归良好的独立影响因素,而糖尿病（OR 6.572,95％ CI1.684 ～25.641;P =0.007）为转归不良的独立影响因素.结论 机械血栓切除术治疗心房颤动所致CES患者的效果优于单纯静脉溶栓,且不会增高病死率和并发症发生率.血管再通良好和机械血栓切除术为心房颤动所致CES患者转归良好的独立影响因素,而糖尿病为转归不良的独立影响因素.Objective To investigate the efficacy and safety of mechanical thrombectomy for cardioembolic stroke （CES） due to atrial fibrillation.Methods Patients with CES admitted to Nanjing First Hospital from January 2015 to September 2017 were enrolled retrospectively.They were divided into the thrombectomy group and the intravenous thrombolysis alone group.The baseline data,the National Institutes of Health Stroke Scale （NIHSS） score at 24 h after treatment,rates of good outcome （defined as the modified Rankin Scale score 0-2） at 90 d after onset,hemorrhagic transformation and death between the two groups were compared.Multivariate logistic regression analysis was used to determine the independent factors for the outcomes in patients with CES.Results A total of 117 patients with CES were enrolket,inchding 65 （55.6%） in the thrombectomy group and 52 （44.4%） in the intravenous thrombolysis alone group.Sixty-two patients （53.0%） had good outcome and 55 （47.0%） had poor outcome.The proportion of patients whose NIHSS score decreased 〉 4 within 24 h after treatment （58.4% vs.26.9%;x2 =6.254,P =0.007）,rates of good recanalization （78.5% vs.57.7%;x2 =5.850,P =0.016）,and good outcome at 90 d （63.1%vs.40.4%;x2 =5.972,P=0.015） in the thrombectomy group were significantly higher than those in the intravenous thrombolysis alone group,while there were no significant differences in the incidences of hemorrhagic transformation,symptomatic intracerebral hemorrhage and gastrointestinal bleeding,as well as mortality at 90 d.Multivariate logistic regression analysis showed that good recanalization （odds ratio [OR] 0.371,95% confidence interval [CI]0.157-0.876;P =0.024） and thrombectomy （OR 0.398,95% CI 0.179-0.883;P =0.024） were the independent factors for good outcome,while diabetes （OR 6.572,95% CI 1.684-25.641;P =0.007） was the independent factor for poor outcome.Conclusion The efficacy of mechanical thrombectomy for patients with CES due to atrial fibrillation is superior to intrave

关 键 词：卒中 脑缺血 颅内栓塞 心房颤动 血栓切除术 血管内手术 血栓溶解疗法 组织型纤溶酶原激活物 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]