颈动脉穿刺溶栓桥接血管内技术治疗急性脑梗死的效果  

The efficacy of carotid puncture and thrombolytic bridging intravascular technique in the treatment of acute cerebral infarction

作　　者：贺辰龙 宋增平 白冰 李文娟 靳振明 邓刘伟 郝金妹 孙学兵 He Chenlong;Song Zengping;Bai Bing(The First People's Hospital of Wu’an,Wu’an Hebei 056300)

机构地区：[1]河北省武安市第一人民医院,056300

出　　处：《卒中与神经疾病》2020年第6期727-733,共7页Stroke and Nervous Diseases

摘　　要：目的分析颈动脉穿刺溶栓桥接血管内技术治疗急性前循环供血区梗死的临床疗效。方法选取2017年1月-2018年12月于本院诊治的急性前循环供血区梗死患者138例,观察组(69例)行颈动脉穿刺溶栓结合血管内技术治疗,对照组(69例)行静脉溶栓结合血管内技术治疗,比较患者的基线资料、诊治、并发症以及死亡情况;采用改良脑梗死溶栓(Modified thrombolysis incerebral infarction,mTICI)量表评估血管再通情况,美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评估神经功能恢复情况,改良Rankin量表(Modifled Rankin scale,mRS)评估患者预后;分析影响患者预后的危险因素。结果与对照组比较,观察组发病至血管开通时间缩短,取栓次数减少(P<0.05),观察组血管成功再通率和mTICI分级高,术后30 d内NIHSS评分降低,术后90 d预后良好率高(P<0.05);入院NIHSS评分≥15分、侧支代偿不良、取栓次数>3次、发病至血管再通时间>250 min均是导致患者预后不良的独立危险因素(P<0.05)。结论颈动脉穿刺溶栓桥接血管内技术治疗急性脑梗死安全有效,可减少取栓次数,缩短发病至血管开通时间,进而提高血管成功再通率和血管再通程度,促进神经功能恢复,同时患者预后良好,未出现并发症和病死率的明显增加。Objective To analyze the clinical efficacy of carotid puncture and thrombolytic bridging intravascular technique in the treatment of cerebral anterior infarction with acute anterior circulation macrovascular obstruction.Methods A total of 138 patients with acute precirculatory large vessel obstruction cerebral infarction diagnosed and treated in our hospital from January 2017 to December 2018 were selected. The observation group(69 cases) received carotid puncture and thrombolysis combined with intravascular technology. The control group(69 cases) received intravenous thrombolysis combined with intravascular technology. Patients’ baseline data, diagnosis and treatment, complications, and mortality were compared. Modified thrombolysis in cerebral thrombosis(mTICI) scale was used to evaluate vascular recanalization. Neurological recovery was assessed by the national institutes of health stroke scale(NIHSS). The modified Rankin scale(mRS) was used to assess patients prognosis. The risk factors influencing the prognosis of patients were analyzed.Results Compared with the control group, the time from onset to vessel opening was shortened, and the number of thrombectomy was reduced in the observation group, with statistically(P<0.05).Compared with the control group, there were higher successful vascular recanalization rate and mTICI grade, lower NIHSS score within 30 d after surgery, and higher prognosis rate at 90 d after surgery in the observation group(P<0.05).The admission NIHSS score ≥15 points, poor collateral compensation, number of thrombectomy removal> 3 times, and onset to vascular recanalization time >250 min were all independent risk factors leading to poor prognosis(P<0.05).Conclusion Carotid puncture and thrombolytic bridging intravascular technology was safe and effective in the treatment of acute cerebral infarction, which could reduce the number of thrombectomy, shorten the time from onset to vascular reopening, and then improve the rate of successful vascular recanalization and degree of vascular

关 键 词：颈动脉穿刺 溶栓 血管内技术 急性脑梗死 临床疗效 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]