5例青年脑梗死患者病因及机械取栓治疗临床分析  

Clinical analysis of etiology and mechanical thrombectomy in 5 young patients with cerebral infarction

作　　者：贺国华 王振[1] HE Guohua;WANG Zhen(Department of Neurology,Changsha Central Hospital,Changsha 410004,China)

机构地区：[1]长沙市中心医院,湖南长沙410004

出　　处：《中国实用神经疾病杂志》2018年第16期1842-1846,共5页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨青年脑梗死的病因、临床表现、机械取栓治疗效果及预后。方法回顾性分析2017-04—2018-04入院的首发急性青年(年龄≤45岁)脑梗死患者5例,分析其病因、临床表现、机械取栓治疗效果及预后。结果 5例患者病因如下:脂肪栓塞1例,颈动脉夹层1例,系统性红斑狼疮1例,可能大脑中动脉夹层1例,不明原因1例。5例患者中3例NIHSS评分≥15分的患者出现意识障碍,2例后循环梗死患者临床症状呈进行性加重且均出现意识障碍。5例患者在常规治疗基础上进行血管内治疗,随访3个月,其中基底动脉闭塞2例患者中,1例采取单纯中间导管吸栓后1次开通血管,1例中间导管吸栓后再支架拉栓1次开通血管,治疗后明显好转。右侧大脑中动脉闭塞3例患者中,1例脂肪栓塞采用单纯中间导管吸栓后部分血管再通,治疗后患者因多器官功能衰竭死亡;1例采取单纯支架拉栓开通血管,1例采取导管吸栓联合支架拉栓开通血管,治疗后2例明显好转。结论青年脑卒中患者病因有其自身特点,机械取栓治疗总体效果好,对于<18岁青少年脑梗死患者进行血管内治疗需进一步探索。Objective To study the etiology,clinical manifestations,mechanical thrombectomy effect and prognosis of cerebral infarction in young patients.Methods Retrospective analysis of 5 patients with acute（age≤45 years old）cerebral infarction admitted to hospital from April 2017 to April 2018,analysis of etiology,clinical manifestations,mechanical thrombectomy and prognosis.Results The causes of the 5 patients were as follows：1 case of fat embolism,1 case of carotid dissection,1 case of systemic lupus erythematosus,1 case of possible middle cerebral artery dissection and 1 case of unknown cause.Among the 5 patients,3 patients with a NIHSS score of 15 or greater presented awareness disorder,and 2 patients with posterior circulation infarction presented progressive increase in clinical symptoms and all presented awareness disorder.All the 5 patients received intravascular therapy on the basis of conventional treatment and were followed up for 3 months.Two patients with basilar artery occlusion,one patient underwent open catheterization with a single intermediate catheter,and one patient underwent internal catheter thrombectomy and stent thrombectomy for 1 time.After treatment,2 patients improved significantly.Among the 3 patients with right middle cerebral artery occlusion,1 patient with fat embolism received partial recanalization after simple internal catheter thrombectomy.After treatment,the patient died of multiple organ failure;1 patient underwent simple stent thrombectomy to open the blood vessel,1 case of catheter thrombectomy combined with stent thrombectomy,the blood vessels were opened,and 2 patients improved significantly after treatment.Conclusion The cause of young stroke patients has its own characteristics,mechanical thrombectomy treatment of the overall effect is good,for young patients with cerebral infarction younger than 18 years old,the need to further explore the intravascular treatment.

关 键 词：脑梗死 脑卒中 青年 大血管闭塞 机械取栓 血管内治疗 病因 临床表现 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]