高龄老年急性缺血性脑卒中患者桥接治疗与直接介入治疗的对比分析  

A comparative analysis of bridging therapy versus direct endovascular treatment in acute ischemic stroke patients aged 80 years and over

作　　者：邓一鸣[1] 张净瑜 高峰[1] 孙瑄[1] 宋立刚[1] 刘恋[1] 莫大鹏[1] 马宁[1] 缪中荣[1] 徐凯[2] Deng Yiming;Zhang Jingyu;Gao Feng;Sun Xuan;Song Ligang;Liu Ligang;Liu Lian;Mo Dapeng;Ma Ning;Miao Zhongrong;Xu Kai(Department of Neuroradiology,Beijing Tiantcui Hospital,Capital Medical University,National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Department of Neurosurgery,Hospital of Jiangsu Provincial Corps,Chinese People's Armed Policer Force,Yangzhou 225003,China)

机构地区：[1]首都医科大学附属北京天坛医院神经介入中心,国家神经系统疾病临床医学研究中心,北京100070 [2]武警江苏总队医院外一科,扬州225003

出　　处：《中华老年医学杂志》2020年第10期1137-1141,共5页Chinese Journal of Geriatrics

基　　金：国家重点研发计划(2016YFC1301501);北京市医院管理中心“青苗”计划专项(QML20180506);首都医科大学科研培育基金(PYZ2018080)。

摘　　要：目的比较桥接治疗与直接介入治疗在发病4.5 h以内到院的80岁及以上高龄老年急性缺血性卒中(AIS)患者中的安全性及有效性。方法选择2016年1月至2019年6月在首都医科大学附属北京天坛医院实施血管内治疗的年龄≥80岁的高龄老年AIS患者89例,按照是否给予静脉溶栓治疗分为桥接治疗组及直接介入治疗两组,比较两组患者的基线信息包括性别构成、发病前改良Rankin量表(mRS)评分、既往病史、吸烟史、术前神经功能缺损程度卒中量表(NIHSS)评分;比较两组手术相关信息包括发病至医院时间、到院至穿刺时间、穿刺到血管开通时间以及并发症(症状性颅内出血、死亡)和90 dm RS评分;采用Logistic回归分析判定给予静脉溶栓的桥接治疗是否为预后的影响因素。结果桥接治疗组共49例患者、直接介入治疗组共40例患者,两组患者基线信息的差异均无统计学意义(均P>0.05)。两组患者在发病至医院时间、到院至穿刺时间、穿刺至血管开通时间指标差异均无统计学意义(均P>0.05);桥接治疗组中26.5%(13例)的患者出现症状性颅内出血,14.3%(7例)患者90 d死亡;直接血管内治疗组中17.5%(7例)患者出现症状性颅内出血及7.5%(3例)的患者90 d死亡,两组症状性颅内出血率和90 d死亡率的差异均无统计学意义(χ2=1.031、1.017,P=0.310、0.313)。以不同临床结局为因变量,调整性别、入院NIHSS、既往病史等因素后采用Logistic回归分析,结果显示,给予静脉溶栓的桥接治疗并不是影响临床结局的因素(OR=0.795,95%CI:0.280~2.258,P=0.666)。结论桥接治疗与直接介入治疗对发病4.5 h以内到院的80岁及以上高龄老年AIS患者同样安全有效,在时间窗内应尽量给予静脉溶栓治疗。Objective To compare the safety and therapeutic effect of bridging therapy versus direct endovascular treatment in patients with acute ischemic stroke(AIS)aged 80 years and over,who received the therapy within 4.5 h of onset.Methods A total of 89 AIS patients aged 80 years and over receiving the endovascular therapy at our hospital from January 2016 to June 2019 were studied with versus without intravenous thrombolysis before endovascular therapy(the former as bridging therapy group,n=49;the latter as the direct endovascular treatment group,n=40).Baseline information including gender,the modified Rankin scale(mRS)score,medical history,Smoking history,preoperative national institute of health Stroke scale(NIHSS)score were collected.Clinical data related to the operation including the times from onset to hospital,door-to-puncture and door-to-recanalization,complications(symptomatic cerebral hemorrhage,mortality)and mRS at 90 d after treatment were compared between the two groups.Multiple logistic regression analy.sis was used to determine whether or not bridging therapy with intravenous thrombolysis was a prognostic factor.Results There was no significant difference in baseline information between the two groups(P〉0.05).The times from onset to hospitaK door-to-puncture,door-to-recanalization had no significant difference between the two groups(P>0.05).There was no significant difference in the incidence of symptomatic cerebral hemorrhage and mortality within 90 d between the two groups(26.5%or 13 cases vs.17.5%or 7 cases,14.3%or 7 cases vs.7.5%or 3 cases,Х^2=1.031 and 1.017,P=0.310 and 0.313).With different clinical outcomes as dependent variables,after adjusting factors such as gender,admission NIHSS and medical history,Logistic regression analysis showed that the bridging therapy with intravenous thrombolysis was not a prognostic factor(OR=0.795,95%CI:0.280~2.258,P=0.666).Conclusions The bridging therapy is as safe and effective as the direct intravascular therapy for AIS patients aged 80 and over within 4.5 h

关 键 词：卒中 血栓溶解疗法 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]