支架取栓治疗急性脑梗死临床效果的单中心研究  

A single-center study on the clinical effect of stent thrombectomy in the treatment of acute cerebral infarction

作　　者：刘春林 徐祥辉[1] 陈惠云 赵爽 李智花 彭闪闪 夏云[1] 王海合[1] 谭西英[1] 郭志勇[1] LIU Chunlin;XU Xianghui;CHEN Huiyun;ZHAO Shuang;LI Zhihua;PENG Shanshan;XIA Yun;WANG Haihe;TAN Xiying;GUO Zhiyong(Xinxiang First People's Hospital/The Affiliated People's Hospital to Xinxiang Medical University,Xinxiang 453000,China)

机构地区：[1]新乡市第一人民医院,新乡医学院附属人民医院,河南新乡453000

出　　处：《中国实用神经疾病杂志》2020年第3期206-211,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的评估支架机械取栓治疗大血管闭塞性急性缺血性脑卒中(acute ischemic stroke,AIS)的疗效,探讨影响临床预后的因素。方法采用单中心研究方法回顾性分析2018-08—2019-05新乡医学院附属人民医院采用支架机械取栓治疗的26例大血管闭塞性AIS患者,对比患者术前及出院时美国国立卫生研究院卒中量表评分(National Institutes of Health stroke scale,NIHSS),并对比术后90 d时改良Rankin量表评分(modified Rankin scale,mRS)评估患者预后情况。结果26例AIS患者中,前循环梗死24例(92.3%),后循环梗死2例(7.7%)。起病至穿刺时间(139.93±120.22)min,穿刺至血管开通时间(115.50±35.23)min。其中8例(30.8%)患者符合静脉溶栓标准,行静脉溶栓治疗后进行桥接取栓治疗。术后即刻造影21例(80.7%)血流再通TICI分级达到2b^3级,其中TICI 2b级8例,TICI 3级13例。术前NIHSS评分15.0±3.52,术后NIHSS评分6.96±3.65,差异有统计学意义(P<0.05)。术后90 d随访,12例(46.2%)预后良好(mRS评分≤2),其中0分4例,1分3例,2分5例。26例中5例(19.2%)出现临床死亡。结论对于大血管闭塞性AIS患者,应用支架取栓技术治疗可以更好地早期开通闭塞血管,改善临床结局。Objective To evaluate the efficacy of mechanical stent thrombectomy for the treatment of acute ischemic stroke with large blood vessel occlusion(AIS),explore the factors that affect the clinical prognosis.Methods A single-center study was performed to retrospectively analyze 26 cases of patients with large-vessel occlusive AIS treated by stent mechanical thrombectomy in People's Hospital Affiliated to Xinxiang Medical College from August 2018 to May 2019.The relevant clinical data were analyzed and the national institutes of health stroke scale(NIHSS)scores were compared before and after discharge.The modified Rankin scale(mRS)was used 90 days after the operation to evaluate the prognosis.Results The general data of 26 AIS patients were ana-lyzed.24(92.3%)had anterior circulation infarction and 2(7.7%)had posterior circulation infarction.The onset to puncture time of 26 patients was(139.93±120.22)min.The time from puncture to vessel opening was(115.50±35.23)min.Eight of the patients met the criteria for intravenous thrombolysis.Standard intravenous thrombolysis was performed first,followed by bridging thrombolysis.Immediate postoperative angiography 21(80.7%)patients had a grade 2b-3 of TICI.There were 8 cases of TICI level 2b and 13 cases of TICI level 3.The preoperative NIHSS score of the patients was 15.0±3.52,and the postoperative NIHSS score was 6.96±3.65,the difference between the two was statistically significant(P<0.05).After 90 days of follow-up,12(46.2%)patients had a good prognosis(mRS score≤2),including 4 patients with 0 score,3 patients with 1 score,and 5 patients with 2 score.Clinical death occurred in 5(19.2%)of the 26 cases.Conclusion For patients with large-vessel occlusive AIS,stent thrombectomy can better open occluded vessels at an early stage,and can improve clinical outcomes.

关 键 词：急性脑梗死 支架取栓 血管内治疗 大血管闭塞 

分 类 号：R743.33[医药卫生—神经病学与精神病学]