桥接治疗和直接取栓治疗发病4.5h内大血管闭塞所致急性缺血性脑卒中的疗效对比分析  

Efficacy analysis of bridging therapy and direct endovascular therapy in ischemic stroke patients with large vessel occlusion within 4.5 h of onset

作　　者：王桂芳[1] 刘书平[2] 卢祖能[2] 肖以磊[3] 夏章勇[1] 杨晓倩[1] 姜桂生[1] 杨霞峰[1] 张利勇[3] 王继跃[3] Wang Guifang;Liu Shuping;Lu Zuneng;Xiao Yilei;Xia Zhangyong;Yang Xiaoqian;Jiang Guisheng;Yang Xiafeng;Zhang Liyong;Wang Jiyue(Department of Neurology,Liaocheng People's Hospital,Liaocheng 252000,China;Department of Neurology,Renmin Hospital,Wuhan University,Wuhan 430060,China;Department of Neurosurgery,Liaocheng People's Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院神经内科,252000 [2]武汉大学人民医院神经内科,武汉430060 [3]聊城市人民医院神经外科,252000

出　　处：《中华神经医学杂志》2020年第9期865-872,共8页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81701159);中国博士后科学基金(2018M632123)。

摘　　要：目的探讨桥接治疗和直接取栓治疗发病4.5 h内大血管闭塞(LVO)所致急性缺血性脑卒中(AIS)(LVO-AIS)患者的疗效。方法回顾性收集聊城市人民医院神经内科自2017年1月至2019年7月收治的154例LVO-AIS患者的临床资料,其中发病3 h内入院88例(桥接治疗54例,直接取栓治疗34例)、发病3.0~4.5 h入院66例(桥接治疗39例,直接取栓治疗27例)。分别统计比较发病3 h内、3.0~4.5 h入院的桥接治疗组和直接取栓治疗组患者的临床资料和疗效的差异,采用多因素Logistic回归分析确定发病3 h内、3~4.5 h入院患者治疗后90 d预后良好的独立保护因素。结果(1)发病3 h内入院患者:与直接取栓治疗组比较,桥接治疗组患者治疗后24 h的神经功能改善率更高(41.2%vs.70.4%),治疗后90 d预后良好者所占比例更高(44.1%vs.66.7%),差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示桥接治疗为发病3 h内入院患者治疗后90 d预后良好的独立保护因素(OR=4.644,95%CI:1.238~12.805,P=0.041)。(2)发病3~4.5 h入院患者:与桥接治疗组比较,直接取栓治疗组患者发病到腹股沟穿刺时间≤4 h者所占比例更高,治疗后90 d预后良好者所占比例更高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示发病至腹股沟穿刺时间≤4 h为发病3~4.5 h入院患者治疗后90 d预后良好的独立保护因素(OR=5.724,95%CI:1.192~11.676,P=0.024)。结论对于LVO-AIS患者,在较早的时间窗入院时,首选桥接治疗;而对于入院较晚的患者,应尽量保证患者在4 h内进行桥接治疗,如果不能保证发病至腹股沟穿刺时间在4 h内,应首选直接取栓治疗。Objective To explore the efficacy of bridging therapy(BT)and direct endovascular therapy(DEVT)in patients with acute ischemic stroke induced by large vessel occlusion(LVO-AIS)within 4.5 h of onset.Methods The clinical data of 154 patients with LVO-AIS within 4.5 h of onset,admitted to our hospital from January 2017 to July 2019,were retrospectively collected.Among them,88 patients were hospitalized within 3 h of onset(54 accepted BT and 34 accepted DEVT);66 patients were hospitalized within 3-4.5 h of onset(39 accepted BT and 27 accepted DEVT).The differences in clinical data and treatment efficacy between patients from the BT group and DEVT group that were hospitalized within 3 h of onset and within 3-4.5 h of onset,respectively,were compared.Multivariate Logistic regression was used to analyze the independent protective factors for favorable outcome 90 d after treatment in patients within 3.0-4.5 h of onset and within 3 h of onset,respectively.Results(1)In patients within 3 h of onset:as compared with the DEVT group,the BT group had significantly higher improvement rate of neurological function at 24 h after treatment(41.2%vs.70.4%)and higher percentage of patients enjoying favorable outcome 90 d after treatment(44.1%vs.66.7%,P<0.05);multivariate Logistic regression analysis showed that BT was an independent protective factor for favorable outcome 90 d after treatment in patients within 3 h of onset(OR=4.644,95%CI:1.238-12.805,P=0.041).(2)In patients within 3-4.5 h of onset:as compared with the BT group,the DEVT group had significantly higher proportion of patients having time from onset to groin puncture≤4 h,and significantly higher proportion of patients with favorable outcome 90 d after treatment(P<0.05);multivariate Logistic regression analysis showed that the time from onset to groin puncture≤4 h was an independent protective factor for favorable outcome 90 d after treatment in patients within 3-4.5 h of onset(OR=5.724,95%CI:1.192-11.676,P=0.024).Conclusion For LVO-AIS patients,BT is the first choice i

关 键 词：桥接治疗 直接取栓治疗 大血管闭塞 急性缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]