急性大血管闭塞卒中发病4．5h内直接取栓与桥接治疗的安全性和有效性比较  

Comparison of safety and efficacy between direct thrombectomy and bridging therapy in acute large vessel occlusion stroke within 4.5 h of onset

作　　者：王一峰 徐运[1] 张雪玲[2] 周俊山[3] 施洪超 李敬伟[1] Wang Yifeng;Xu Yun;Zhang Xueling;Zhou Junshan;Shi Hongchao;Li Jingwei(Deportment of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China;Department of Neurology, Suqian People＇s Hospital of Nanjing Drum Tower Hospital Group, Suqian 223800, China;Department of Neurology, Nanjing First Hospital, Nanjing 210006, Chin)

机构地区：[1]南京大学医学院附属鼓楼医院神经内科,210008 [2]南京鼓楼医院集团宿迁市人民医院神经内科,223800 [3]南京市第一医院神经内,210006

出　　处：《国际脑血管病杂志》2018年第4期257-261,共5页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金面上项目（81571134）;青年科学基金项目（81200896）;江苏省博士后科研资助计划（1501077A）;江苏省六大人才高峰D类资助项目（2015-WSN-084）;江苏省医学重点学科（实验室）（ZDXKA2016020）

摘　　要：目的 比较急性颅内大血管闭塞性卒中患者在发病4.5 h内直接取栓与桥接治疗的安全性和有效性.方法 收集2014年4月至2017年9月在南京大学医学院附属鼓楼医院行急诊机械取栓的急性大血管闭塞性卒中患者,筛选符合静脉溶栓资格且发病时间≤4.5 h的患者,运用倾向评分匹配分析和McNemar检验比较直接取栓与桥接治疗的安全性和有效性.结果 共纳入急性大血管闭塞卒中患者41例,最终倾向评分匹配12对.直接取栓组入院至股动脉置鞘时间明显较短（P=0.03）,但两组患者90 d时功能转归良好率、病死率和有症状脑出血发生率均无显著性差异.结论急性大血管闭塞性卒中患者在发病4.5 h内启动直接机械取栓治疗可能是安全和有效的,并能显著缩短血管再通时间.Objective To compare the safety and efficacy of directly thrombectomy and bridging therapy in patients with acute large vessel occlusion stroke within 4.5 h of onset.Methods From April 2014 to September 2017, patients with acute large vessel occlusion stroke treated with emergency mechanical thrombectomy in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were collected. The patients who were eligible for intravenous thrombolysis and whose onset time was ≤4.5 h were selected. The propensity score matching analysis and McNemar test were used to compare the safety and efficacy of direct mechanical thrombectomy and bridging therapy. Results A total of 41 patients with acute large vessel occlusion stroke were enrolled.The final propensity score matching was 12 pairs.In the direct thrombectomy group, the time from door to femoral artery sheath placement was significantly reduced （P=0.03）, but there was no significant difference in the good functional outcome rate, mortality rate, and incidence of symptomatic intracranial hemorrhage between the two groups of patients at 90 d（P〉0.05）.Conclusion It is safe and effective to start direct mechanical thrombectomy within 4.5 h of onset in patients with acute large vessel occlusion stroke and can significantly shorten the time of vascular recanalization.

关 键 词：卒中 脑缺血 血栓切除术 血管内手术 血栓溶解疗法 输注 静脉内 倾向评分 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]