血管内支架成形术和药物治疗对症状性大脑中动脉狭窄的疗效比较  

Comparative Analysis of Endovascular Stenting and Medicinal Therapy in Symptomatic Mid⁃dle Cerebral Artery Stenosis

作　　者：丁轶[1] 朱谱国[1] 张荣[1] 叶方斌[1] 胡殿波 DING Yi;ZHU Pu-guo;ZHANG Rong;YE Fang-bin;HU Dian-bo(Department of Neurology,Hubei Aerospace Hospital,Hubei Xiaogan 432000,China)

机构地区：[1]湖北航天医院神经内科,湖北孝感432000

出　　处：《神经损伤与功能重建》2021年第10期579-582,共4页Neural Injury and Functional Reconstruction

摘　　要：目的:比较血管内支架成形术与单纯药物治疗对症状性大脑中动脉狭窄(MCAS)的疗效。方法:症状性MCAS患者70例纳入研究,随机分为支架组和药物组,各35例。支架组采取血管内支架成形术治疗,并在术后服用抗血栓药物,药物组给予单纯抗血栓、调脂、降压药物等治疗。比较2组治疗1月、6月、1年后脑卒中及死亡发生情况;比较2组治疗前后血管狭窄率、改良Rankin(mRS)评分、美国国立卫生院卒中量表(NIHSS)评分、收缩压、舒张压、糖化血红蛋白、总胆固醇、狭窄段收缩期峰值流速、狭窄段舒张末期流速及血管搏动指数。结果:支架组治疗1年后脑卒中发生率为8.57%,显著低于药物组的28.57%(P<0.05)。支架组治疗后血管狭窄率、mRS评分、NIHSS评分显著低于治疗前及药物组治疗后(P<0.05)。2组治疗后收缩压、舒张压、糖化血红蛋白、总胆固醇水平低于治疗前(P<0.05),但2组间差异无统计学意义。支架组治疗后MCA狭窄段收缩期峰值流速、狭窄段舒张末期流速显著低于治疗前及药物组治疗后,血管搏动指数显著高于治疗前及药物组治疗后(P<0.05)。结论:血管内支架成形术治疗症状性MCAS比单纯药物治疗有更好的临床远期疗效,能更好的改善患者神经功能和脑血流速度。Objective:To compare the clinical effect of endovascular stenting and medicinal intervention in symptomatic middle cerebral artery stenosis(MCAS).Methods:Seventy patients with symptomatic MCAS were enrolled.The patients were randomly divided into the stent group and drug group,with 35 cases in each.The stent group was treated with sent angioplasty and antithrombotic drugs after operation.The drug group was treated with antithrombotic drugs,lipid-lowering drugs,and antihypertensive drugs.The incidence of stroke and death were compared between the two groups at 1 month,6 months,and 1 year after treatment.The stenosis rate,modified Rankin(mRS)score,National Institutes of Health Stroke Scale(NIHSS)score,systolic blood pressure(SBP),diastolic blood pressure(DBP),HbA1c,total cholesterol(TC),peak systolic velocity(PSV),end-diastolic velocity(EDV),and pulsatility index(PI)were compared between the two groups before and after treatment.Results:One year after treatment,the incidence of stroke in the stent group was 8.57%,which was significantly lower than the 28.57%of the drug group(P<0.05).The stenosis rate,mRS score,and NIHSS score in the stent group were significantly lower than before treatment and after treatment in the drug group(P<0.05).The SBP,DBP,HbA1c,and TC in both groups were significantly lower than those before treatment(P<0.05)but showed no significant difference when comparing the groups with each other.After treatment,PSV and EDV in the stent group were significantly lower than those before treatment and after treatment in the drug group,and PI was significantly higher than those before treatment and after treatment in the drug group(P<0.05).Conclusion:Endovascular stenting has better long-term clinical effect in the treatment of symptomatic MCAS than simple medicinal therapy and can better improve nerve function and cerebral blood flow velocity.

关 键 词：血管内支架成形术 大脑中动脉狭窄 药物治疗 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]