急性前循环大血管闭塞性脑卒中直接机械取栓与桥接治疗的对照研究  

Comparative study of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large-artery occlusive stroke

作　　者：任海兵 刘慧琴[1] 王思思[1] 张健颖 杨文进[1] 赵晓晖[1] 青科[1] 肖国栋[2] 曹勇军[2] Ren Haibing;Liu Huiqin;Wang Sisi;Zhang Jianying;Yang Wenjin;Zhao Xiaohui;Qing Ke;Xiao Guodong;Cao Yongjun(Department of Neurology,Pudong New Area People's Hospital,Shanghai 201299,China;Department of Neurology,Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]上海市浦东新区人民医院神经内科,201299 [2]苏州大学附属第二医院神经内科,苏州215004

出　　处：《中华神经医学杂志》2020年第2期131-137,共7页Chinese Journal of Neuromedicine

摘　　要：目的对比分析急性前循环大血管闭塞性脑卒中直接机械取栓与桥接治疗的安全性和有效性的差异。方法回顾性收集上海市浦东新区人民医院神经内科、苏州大学附属第二医院神经内科自2015年10月至2018年3月收治的116例急性前循环大血管闭塞性脑卒中患者的临床资料,其中接受直接机械取栓63例(直接机械取栓组),接受桥接治疗53例(桥接组)。采用统计学方法分析比较2组患者间术前基线资料、诊治情况以及术后即刻血管有效再通率、术后出血转化发生率及症状性颅内出血率、术后90 d改良Rankin量表(mRS)评分和病死率等安全性和有效性指标的差异。结果直接机械取栓组患者的术前Alberta卒中项目早期CT评分(ASPECTS)、格拉斯哥昏迷量表(GCS)评分均明显低于桥接组,发病至就诊时间明显长于桥接组,差异均有统计学意义(P<0.05)。直接机械取栓组与桥接组患者间术后出血转化发生率(34.9%vs.17.0%)差异有统计学意义(P<0.05),但在血管有效再通率(69.8%vs.79.3%)、症状性颅内出血率(15.9%vs.7.6%)、术后90 d预后良好率(28.6%vs.35.9%)和病死率(22.2%vs.17.0%)方面差异均无统计学意义(P>0.05)。结论直接机械取栓与桥接治疗对急性前循环大血管闭塞性脑卒中的临床疗效和安全性相似。Objective To comparatively analyze the safety and efficacy of direct mechanical thrombectomy and bridging therapy for patients with acute anterior circulation large-artery occlusive stroke.Methods A total of 116 patients with acute anterior circulation large-artery occlusive stroke,admitted to our hospitals from October 2015 to March 2018,were chosen in our study;their clinical data were analyzed retrospectively.Among them,63 patients accepted direct mechanical thrombectomy and 53 accepted bridging therapy.The preoperative baseline data and the diagnoses and treatments of the two groups were analyzed;the degrees of modified thrombolysis in cerebral infarction(mTICI),incidences of hemorrhage transformation and symptomatic intracranial hemorrhage,and modified Rankin scale(mRS)scores and mortality rate 90 d after operation were compared between the two groups.Results The preoperative Alberta stroke program early CT scale(ASPECTS)and Glasgow Coma Scale(GCS)scores of the direct mechanical thrombectomy group were significantly lower than those of the bridge therapy group(P<0.05),and the time from onset to admission was significantly longer than that of the bridging therapy group(P<0.05).The incidence of postoperative hemorrhage transformation in the direct mechanical thrombectomy group was significantly higher than that in the bridging therapy group(34.9%vs.17.0%,P<0.05),but there were no significant differences in the effective recanalization rate(69.8%vs.79.3%),intracranial symptomatic hemorrhage rate(15.9%vs.7.6%),favorable outcome rate(28.6%vs.35.9%)and mortality(22.2%vs.17.0%)between the two groups(P>0.05).Conclusion The clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for patients with acute anterior circulation large-artery occlusive stroke are similar.

关 键 词：缺血性脑卒中 前循环 机械取栓 静脉溶栓 桥接治疗 

分 类 号：R74[医药卫生—神经病学与精神病学]