静脉溶栓在急性前循环大血管闭塞性脑卒中血管内治疗中的作用  

The role of intravenous thrombolysis in the endovascular treatment of acute anterior circulation vascular occlusive stroke

作　　者：周峰[1] 施洪超[1] 陆敏[1] 王伟[1] 候建康 刘宇恺[1] 张颖冬[1] 周俊山[1] Zhou Feng;Shi Hongchao;Lu Min;Wang Wei;Hou Jiankang;Liu Yukai;Zhang Yingdong;Zhou Junshan(Department of Neurology,Nanjing First Hospital,Nanjing Medical University,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)神经内科,210006

出　　处：《中华神经科杂志》2019年第6期472-477,共6页Chinese Journal of Neurology

基　　金：江苏省卫计委面上科研项目(H201541);南京市卫计委重大研究项目(ZDX16002);南京市卫计委"十三五"科研项目(ZKX16050).

摘　　要：目的探讨静脉溶栓治疗在急性前循环大血管闭塞性脑卒中血管内治疗中的作用及安全性。方法回顾性收集南京医科大学附属南京医院2015年5月至2018年5月收治的226例血管内治疗的急性前循环大血管闭塞性脑卒中患者临床资料,根据是否行静脉溶栓分为单纯取栓组(112例)和桥接治疗组(114例)。采用改良脑梗死溶栓分级(mTICI)评价血管开通效果,并比较两组血管再通时间、mTICI、症状性颅内出血率以及术后90d改良Rankin量表(mRS)评分。结果两组患者性别、年龄、既往史、美国国立卫生研究院卒中量表评分均差异无统计学意义(均P>0.05)。两组患者就诊-血管开通时间差异无统计学意义(P>0.05)。剔除醒后卒中及发病时间不明患者,单纯取栓组(63例)和桥接治疗组(111例)的发病-就诊时间[分别为(235.04±182.64)min和(102.48±60.51)min,t=7.01,P<0.01]和发病-血管开通时间[分别为(405.31±148.89)min和(337.31±117.65)min,t=3.32,P=0.01]差异均有统计学意义。单纯取栓组的取栓次数[(2.55±1.52)次]高于桥接治疗组[(2.11±1.48)次;t=2.246,P<0.05]。总的血管开通率(mTICI2b/3级)为89.8%(203/226),其中单纯取栓组为88.4%(99/112),桥接治疗组为91.2%(104/114),两组比较差异无统计学意义(P>0.05)。单纯取栓组与桥接治疗组在症状性颅内出血率[分别为8.93%(10/112)和11.4%(13/114)]、病死率[分别为12.5%(12/112)和16.7%(19/114)]以及90d良好预后(mRS评分0~2分)率[分别为54.5%(61/112)和55.8%(63/114)]均差异无统计学意义(均P>0.05)。结论在急性前循环大血管闭塞性脑卒中的血管内治疗的患者中,静脉溶栓能减少取栓的次数,并不增加就诊到血管开通的时间,也不增加症状性颅内出血风险、病死率,良好预后率与单纯取栓组相近,因此,静脉溶栓对于急性前循环大血管闭塞性脑卒中血管内治疗安全有效。Objective To investigate the effect and safety of intravenous thrombolytic therapy in the endovascular treatment of acute anterior circulation vascular occlusive stroke. Methods The clinical data of 226 patients with acute anterior circulation vascular occlusive stroke who underwent endovascular treatment in Nanjing First Hospital, Nanjing Medical University from May 2015 to May 2018 were retrospectively collected. According to whether or not intravenous thrombolysis was performed, the patients were classified into simple thrombectomy group (n=112) and bridging treatment group (n=114). The modified Thrombolysis in Cerebral Infarction Score (mTICI) was used to evaluate the vascular opening effect, and the blood vessel recanalization time, mTICI, the symptomatic intracranial hemorrhage rate, and the modified Rankin Scale (mRS) score at 90 days after surgery were evaluated. Results There were no statistically significant differences in gender, age, past history and National Institute of Health Stroke Scale score between the two groups (P>0.05). There was no statistically significant difference in door-to-recanalization time between the two groups (P>0.05). Excluding the patients with post-wake stroke and unexplained onset time, the simple thrombectomy group (n=63) and the bridging treatment group (n=111) showed statistically significant differences in onset-to-door time ((235.04±182.64) min vs (102.48±60.51) min, t=7.01, P<0.01) and onset-to-recanalization time ((405.31±148.89) min vs (337.31±117.65) min, t=3.32, P=0.01). The difference in number of thrombectomy between the simple thrombolysis group (2.55±1.52) and the bridging treatment group (2.11±1.48) was statistically significant (t=2.246, P=0.026). The total reperfusion (mTICI 2b/3) rate was 89.8%(203/226), 88.4%(99/112) in the simple thrombectomy group and 91.2%(104/114) in the bridging treatment group, with no statistically significant difference between the two groups (P>0.05). The differences in symptomatic intracranial hemorrhage rate (8.93%(10/112)

关 键 词：卒中 血栓溶解疗法 血管内治疗 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]