桥接法与直接取栓法治疗急性后循环缺血性卒中的疗效比较及预后影响因素分析  

Clinical analysis of bridging thrombectomy and direct thrombectomy in the treatment of acute posterior circulation ischemic stroke

作　　者：张东焕 张保朝[1] 高军 康梅娟[1] 刘义锋[1] 汪宁[1] 孙军[1] 陈笛[1] 王洁[1] 温昌明[1] Zhang Donghuan;Zhang Baochao;Gao Jun;Kang Meijuan;Liu Yifeng;Wang Ning;Sun Jun;Chen Di;Wang Jie;Wen Changming(Department of Neurology,Nanyang City Central Hospital,Nanyang 473000,China)

机构地区：[1]河南省南阳市中心医院神经内科,473000

出　　处：《中华解剖与临床杂志》2021年第3期293-297,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨桥接法和直接取栓治疗急性后循环缺血性卒中患者的临床疗效、安全性以及预后影响因素。方法回顾性研究。纳入2018年1月—2019年12月南阳市中心医院神经内科的急性后循环缺血性卒中患者67例,其中男52例、女15例,年龄51~74岁。按治疗方法不同分为两组:采用直接机械取栓治疗者34例纳入直接取栓组,采用静脉阿替普酶溶栓联合机械取栓桥接治疗者33例纳入桥接治疗组。术后即时采用数字减影血管造影评估血管再通率,术后48 h复查CT评估颅内出血发生率,术前及术后第90天采用改良Rankin量表(mRS)评分评价患者神经功能情况,统计两组患者术后90 d内病死率。通过比较2组患者的临床基线资料以及上述各观察指标,评估两种治疗方案的有效性及安全性;采用多因素logistic回归分析筛选术后90 d内患者死亡的独立危险因素。结果两组患者年龄、性别分布、术前美国国立卫生研究院卒中量表(NIHSS)评分、病因分型、发病时间、血管闭塞部位等临床基线资料比较,差异均无统计学意义(P值均>0.05);桥接治疗组与直接取栓组合并心房颤动的患者占比分别为9.1%(3/33)和32.4%(11/34),差异有统计学意义(χ^(2)=5.195,P<0.05)。桥接治疗组术后第90天神经功能恢复良好(mRS评分为0~2分)的患者占比高于直接取栓组,分别为51.5%(17/33)和29.4%(10/34),但组间比较差异无统计学意义(χ^(2)=3.401,P>0.05);桥接治疗组、直接取栓组术后血管再通率和术后90 d内死亡率分别为75.8%(25/33)、58.8%(20/34)和27.3%(9/33)、29.4%(10/34),两组差异无统计学意义(P>0.05)。桥接治疗组患者术后48 h并发颅内出血1例(3.03%),直接取栓组则无一例并发颅内出血,两组差异无统计学意义(χ^(2)=1.046,P>0.05)。logistic回归分析结果提示,入院时NIHSS评分为术后90 d内患者死亡的独立危险因素[OR(95 CI)为1.208(1.059~1.377),P<0.01]。结论直接取栓治疗与桥�Objective This study aimed to explore the efficacy and safety of bridging therapy and direct thrombectomy in the treatment of acute posterior circulation ischemic stroke and analyze the prognostic factors.Methods This observational study involved 67 patients with acute posterior circulation ischemic stroke in Nanyang City Central Hospital from January 2018 to December 2019.The patients,who comprised 52 males and 15 females aged 51-74 years old,were received the treatment of direct thrombectomy or bridging therapy.The patients were divided into two groups according to different treatment methods.Thirty-four patients who received direct mechanical thrombectomy were included in the direct thrombectomy group,and 33 patients who received intravenous alteplase thrombolysis combined with mechanical thrombectomy and bridging were included in the bridging treatment group.Digital subtraction angiography was used to evaluate the vascular recanalization rate immediately after the operation,and the incidence of intracranial hemorrhage was evaluated by CT 48 hours after the operation.The modified Rankin scale(mRS)was used to evaluate the neurological recovery of the patients before and on the 90th day after the operation.The mortality rate within 90 days after operation was determined.The effectiveness and safety of the two treatment options were evaluated by comparing the clinical baseline data of the two groups of patients and the above-mentioned observation indicators.Multivariate logistic regression analysis was performed to screen independent risk factors for mortality within 90 days after surgery.Results The data from the two groups of patients were compared with clinical baseline data,such as age,gender distribution,preoperative National Institutes of Health stroke scale(NIHSS)score,etiology classification,onset time,and vascular occlusion location.The difference was not statistically significant(all P values>0.05).The proportion of patients with atrial fibrillation in the bridging treatment group and direct thrombus re

关 键 词：卒中 后循环 桥接治疗 机械取栓 预后 

分 类 号：R651.1[医药卫生—外科学]