机械取栓治疗急性缺血性卒中的疗效评价——单中心数据分析  

Efficacy evaluation of mechanical thrombectomy for acute ischemic stroke: A single center data analysis

作　　者：邢鹏飞[1] 沈红健 张磊[1] 李子付[1] 方亦斌[1] 李强[1] 赵瑞[1] 黄清海[1] 洪波[1] 许奕[1] 张永巍[1] 杨鹏飞[1] 邓本强[1] 刘建民[1] Xing Pengfei;Shen Hongjian;Zhang Lei;Li Zifu;Fang Yibin;Li Qiang;Zhao Rui;Huang Qinghai;Hong Bo;Xu Yi;Zhang Yongwei;Yang Pengfei;Deng Benqiang;Liu Janmin(Cerebrovascular Disease Center,Changhai Hospital,Naval Medical Unversity(The Second Military Medical University),Shanghai200433,China)

机构地区：[1]海军军医大学(第二军医大学)附属长海医院脑血管病中心,上海200433

出　　处：《中国微侵袭神经外科杂志》2020年第4期157-160,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：2017年中国脑卒中高危人群干预适宜技术研究及推广项目(编号:GN-2017R0001)。

摘　　要：目的评价急性缺血性卒中行机械取栓的疗效与安全性。方法回顾性分析513例行机械取栓治疗的急性缺血性卒中病例资料,根据临床预后分为良好预后组(n=299)和不良预后组(n=214)。主要评价指标为90 d预后良好率,次要评价指标为血管成功再通率、挽救技术比例、并发症及病死率等。结果机械取栓术后血管成功再通率(mTICI 2b^3级)为93.8%(481/513),术后90 d预后良好率(mRS 0~2分)为58.3%(299/513),颅内出血率为22.0%(113/513),其中症状性颅内出血率为9.6%(49/513),病死率为12.9%(66/513)。多因素回归分析表明:术前NIHSS<22分、代偿评分≥2分、血管再通达mTICI 2b^3级及术后无出血,与良好预后密切相关(均P <0.05)。结论机械取栓能明显改善颅内大血管闭塞和(或)远端血管闭塞的临床预后。低NIHSS评分、良好代偿、血管成功再通及无出血是机械取栓90 d预后良好的独立预测因素。Objective To evaluate the efficacy and safety of the mechanical thrombectomy for acute ischemic stroke. Methods The clinical data of 513 patients with acute ischemic stroke undergoing mechanical thrombectomy were analyzed retrospectively. The patients were divided into good prognosis group(n = 299) and poor prognosis group(n = 214) according to clinical prognosis. The main evaluation index was the good prognosis rate at 90 days, and the secondary evaluation indicators were the successful recanalization rate of blood vessels, the proportion of rescue techniques, complications and mortality. Results The successful recanalization rate(m TICI2 b-3) after mechanical thrombectomy was 93.8%(481/513), the good prognosis rate(m RS 0-2 points) at 90 days was 58.3%(299/513),and the intracranial hemorrhage rate was 22.0%(113/513), among which, the symptomatic intracranial hemorrhage rate 9.6%(49/513) and the mortality was 12.9%(66/513). Multivariate regression analysis showed that: preoperative NIHSS < 22 points, collateral circulation score ≥ 2 points, revascularization of m TICI 2 b-3 and no intracranial hemorrhage after mechanical thrombectomy were closely related to good prognosis(all P < 0.05). Conclusions Mechanical thrombectomy can significantly improve the clinical prognosis of intracranial vascular occlusion and/or distal vascular occlusion. Low NIHSS, good collateral circulation, recanalization to m TICI 2 b-3 grade and no intracranial hemorrhage are independent predictors of good prognosis at 90 days after mechanical thrombectomy.

关 键 词：脑血管意外 血管内治疗 取栓 机械 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]