多模式血管再通治疗急性大动脉闭塞性脑梗死的临床研究  

Clinical Study of Multimode Vascular Recanalization in the Treatment of Acute Large Artery Occlusive Cerebral Infarction

作　　者：谷守维 李立花 梁静 王东明 GU Shou-wei;Li Li-hua;LIANG Jing(The 981th Hospital of People's Liberation Army, Hebei 067000, China)

机构地区：[1]河北省承德市解放军第981医院神经外科,067000 [2]河北省承德市解放军第981医院护理部,067000

出　　处：《心脑血管病防治》2019年第2期133-136,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨多模式血管再通治疗急性大动脉闭塞性脑梗死患者的疗效。方法选择急性大动脉闭塞性脑梗死患者40例,采用动脉内溶栓、取栓、球囊扩张、支架置入等多模式血管再通治疗,观察患者血管再通情况,采用美国国立卫生研究院脑卒中量表(NIHSS)评分比较术前及术后24h患者神经功能变化,使用改良Rankin量表(mRS)对患者术后3个月的预后进行评估。依据mRS评分将40例患者分成预后良好组(mRS≤2分)及预后不良组(mRS≥3分),探讨影响患者预后的危险因素。结果 40例患者均接受3个月的随访,其中血管再通成功患者32例(80. 00%);术前NIHSS平均评分为(15. 71±5. 14)分,与术后24h的NIHSS平均评分为(11. 50±5. 32)分,比较差异有统计学意义(P <0. 05)。术后3个月随访出现症状性、无症状性的颅内出血9例(22. 50%)。有2例发生死亡,存活38例中,预后良好组25例(65. 79%),预后不良组13例(34. 21%)。预后良好组及预后不良组在术前NIHSS评分、发病-穿刺时间、穿刺-开通时间、年龄、高血压、心房颤动、局部麻醉、取栓次数、取出栓子、支架成形、动脉溶栓、静脉溶栓、球囊扩张、替罗非班使用等方面比较差异无统计学意义(P>0. 05);在术后24h NIHSS评分、性别、糖尿病、血管再通分级等方面比较差异有统计学意义(P <0. 05)。多因素Logistic回归分析显示,血管再通级别高是良好预后的保护因素,而糖尿病属于患者预后不良的一个独立危险因素。结论多模式血管再通治疗急性大动脉闭塞性脑梗死效果显著,血管开通率较高,预后良好。血管再通级别越高,患者预后越好。糖尿病具有比较高的出血转化风险,可能是急性大动脉闭塞性脑梗死患者预后不良的独立危险因素。Objective To study the efficacy of multimode vascular recanalization in the treatment of acute cerebral infarction patients with acute arterial occlusive disease. Methods 40 cases of patients with acute arterial occlusive cerebral infarction were treated by intra-arterial thrombolysis,thrombectomy,balloon dilation,stent placement and other modes of recanalization therapy. Vascular recanalization of patients were observed,changes of nerve function in patients with 24 h scores by the National Institutes of Health Stroke Scale( NIHSS) were compared before and after the operation,the prognosis of patients after 3 months were accessed using the modified Rankin scale( mRS). According to the mRS score,40 cases were divided into good prognosis group( mRS≤2) and poor prognosis group( mRS≥3) to investigate the risk factors of the prognosis. Results40 cases underwent 3 months of follow-up,There were 32 cases with successful recanalization( 80. 00%). The average preoperative NIHSS score was( 15. 71 ± 5. 14),the average postoperative NIHSS score at 24 h was( 11. 50 ± 5. 32),with statistically significant differences( P < 0. 05). After 3 months of follow-up,there were 2 cases of death;25 cases in good prognosis group( 62. 50%) and 13 cases in poor prognosis group( 32. 50%),9 cases of symptomatic and asymptomatic intracranial hemorrhage( 22. 50%). There were no significant difference between the good prognosis group and poor prognosis group in the preoperative NIHSS score,onset time of puncture,puncture-opening time,age,hypertension,atrial fibrillation,local anesthesia,general anesthesia,thrombectomy times,recanalizations stent,the forming,intravenous thrombolysis,intra-arterial thrombolysis,balloon dilatation,tirofiban( P > 0. 05). There were significant difference between the two gourps in the postoperative 24 h NIHSS score,gender,diabetes,vascular recanalization grade( P < 0. 05). Multivariate Logistic regression analysis showed that a high level of vascular recanalization is a protective factor for good prognosis,and

关 键 词：多模式血管再通 脑梗死 大动脉闭塞 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]