单中心急性前循环大血管闭塞性醒后脑卒中血管内治疗有效性与安全性研究  

Efficacy and safety of endovascular therapy for wake-up stroke with acute large vessel occlusion of anterior circulation in a single stroke center

作　　者：王立志[1] 朱晔宁[1] 邓宇平[1] 李朱勤[1] 刘武[1] Wang Lizhi;Zhu Yening;Deng Yuping;Li Zhuqin;Liu Wu(Department of Neurology,Huizhou Municipal Central Hospital,Huizhou 516001,China)

机构地区：[1]惠州市中心人民医院神经内科,惠州516001

出　　处：《新医学》2021年第7期494-499,共6页Journal of New Medicine

基　　金：惠州市科技计划项目(2019Y045)。

摘　　要：目的探讨急性前循环大血管闭塞性醒后脑卒中血管内治疗的安全性及有效性。方法收集急性前循环大血管闭塞性缺血性脑卒中患者,以CT血管成像(CTA)证实颈内动脉或大脑中动脉M1段闭塞、Alberta脑卒中项目早期CT(ASPECT)评分≥6分及美国国立卫生研究院卒中量表(NIHSS)评分≥6分为主要入组标准,以术后24 h及术后7 d NIHSS评分评估患者神经功能缺损改善程度,以术后90 d改良Rankin量表(mRS)评分评估患者预后。按发病时间分为醒后卒中组和非醒后卒中组,比较2组基线资料、手术相关特征、术后脑出血率、术后90 d病死率、术后24 h及术后7 d NIHSS评分、术后90 d预后良好患者比例。结果共纳入53例急性前循环大血管闭塞性缺血性脑卒中患者,其中醒后卒中组18例、非醒后卒中组35例。醒后卒中组与非醒后卒中组的年龄、性别构成、脑卒中危险因素、入院NIHSS评分、脑卒中病因学分型、ASPECT评分比较差异均无统计学意义(P均>0.05)。醒后卒中组术前静脉溶栓患者的比例低于非醒后卒中组(11%vs.57%,P<0.05),2组的入院至穿刺时间、责任血管、血管内治疗方式、血管再通率、术后脑出血率、术后90 d病死率比较差异均无统计学意义(P均>0.05)。醒后卒中组和非醒后卒中组术后24 h及术后7 d NIHSS评分均比入院时下降(P均<0.025),2组间入院时、术后24 h及术后7 d NIHSS评分比较差异均无统计学意义(P均>0.05)。术后90 d时醒后卒中组预后良好患者占56%(10/18),非醒后卒中组预后良好患者占63%(22/35),组间比较差异无统计学意义(P>0.05)。结论部分急性前循环大血管闭塞性醒后脑卒中血管内治疗安全、有效。Objective To evaluate the safety and efficacy of endovascular therapy for wake-up stroke with acute large vessel occlusion of the anterior circulation.Methods Ischemic stroke patients with acute large vessel occlusion of the anterior circulation who were treated with endovascular therapy were retrospectively recruited.The occlusion of internal carotid artery or M1 segment of the middle cerebral artery was diagnosed by computer tomography angiography(CTA),Alberta Stroke Program Early CT(ASPECT)score≥6 and National Institute of Health Stroke Scale(NIHSS)score≥6 were used as the primary inclusion criteria.The NIHSS scores at 24 h and 7 d after operation were utilized to evaluate the improvement of neurological deficit.The modified Rankin Scale(mRS)score at 90 d after operation was used to evaluate clinical prognosis.All patients were divided into the wake-up stroke group and non-wake-up stroke group according to the time of onset.The baseline data,features of operation,cerebral hemorrhage rate after operation,mortality rate at 90 d after operation,NIHSS scores at 24 h and 7 d after operation,proportion of patients with good prognosis at 90 d after operation were statistically compared between two groups.Results A total of 53 ischemic stroke patients with acute large vessel occlusion of the anterior circulation were enrolled,including 18 patients in the wake-up stroke group and 35 patients in the non-wake-up stroke group.Age,gender,stroke risk factors,NIHSS score on admission,stroke etiology classification and ASPECT score did not significantly differ between two groups(all P>0.05).The proportion of patients with preoperative intravenous thrombolysis in the wake-up stroke group was remarkably lower than that in the non-wake-up stroke group(11%vs.57%;P<0.05).The door-to-puncture time,responsible vessel,protocol of endovascular therapy,vascular recanalization rate,cerebral hemorrhage rate after operation and mortality rate at 90 d after operation did not significantly differ between two groups(all P>0.05).In both g

关 键 词：醒后脑卒中 血管内治疗 机械取栓 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]