中等血管闭塞型急性缺血性卒中机械取栓倾向性的现况调查  

Survey on the propensity for mechanical thrombectomy for acute ischemic stroke with medium vessel occlusion

作　　者：周一汉 张小曦 叶小飞[2] 李群 李密 张永巍 杨鹏飞 刘建民 Zhou Yihan;Zhang Xiaoxi;Ye Xiaofei;Li Qun;Li Mi;Zhang Yongwei;Yang Pengfei;Liu Jianmin(Cerebrovascular Disease Center,the First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China;Department of Medical Statistics,Naval Medical University,Shanghai 200433,China;Academic Affairs Office,Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院脑血管病中心,上海200433 [2]海军军医大学军队卫生统计学教研室,上海200433 [3]海军军医大学教务处,上海200433

出　　处：《中华神经外科杂志》2022年第3期300-304,共5页Chinese Journal of Neurosurgery

基　　金：中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2020R0008);上海市扬帆计划(20YF1448000);长海医院青年启动基金(2018QNA007)。

摘　　要：目的对中等血管闭塞型急性缺血性卒中(MeVO)机械取栓的倾向性进行现况调查。方法2019年1月至2020年1月选取我国150家能够行机械取栓术的三级医院的医生作为调查对象。回收126家医院中的131名医生的问卷进行研究。参照埃森高级神经介入课程设计的研究问卷,采用问卷星方式回收问卷。问卷内容包括:(1)被访医院、医生的情况。(2)设计6例轻症MeVO病例:有、无阿替普酶溶栓禁忌证组各3例,每组包括大脑中动脉M3段、大脑前动脉A2段、大脑后动脉P2段(以下简称M3、A2、P2段)闭塞者各3例。调查被访医生对6例病例采取的治疗方案(立即行机械取栓、拒绝行机械取栓及溶栓失败后采取机械取栓)。(3)设计年龄为40~、50~、60~、70~、≥80岁的5例典型MeVO病例,调查对不同年龄病例采取的治疗策略。(4)调查临床实践中采用机械取栓治疗MeVO的难题和可能的解决方案。结果131例医生中,选择对6例病例均拒绝行机械取栓的比率均>30%[30.5%(40名)~47.3%(62名)]。对于无溶栓禁忌证的M3段闭塞者,选择立即行机械取栓的比率为11.5%(15名),A2、P2段分别为33.6%(44名)、29.8%(39名),差异有统计学意义(P<0.001);选择溶栓失败后行机械取栓的比率,M3段闭塞者为58.0%(76名),A2、P2段分别为22.1%(29名)、22.9%(30名),差异有统计学意义(P<0.01)。对于有溶栓禁忌证的M3段闭塞者,选择立即行机械取栓的比率为55.7%(73名),A2、P2段分别为68.7%(90名)、58.0%(76名),差异无统计学意义(P=0.720)。对于40~、50~、60~、70~、≥80岁的患者,选择采用机械取栓治疗的比率分别为86.3%(113名)、84.8%(111名)、85.5%(112名)、77.9%(102名)、48.9%(64名),差异有统计学意义(P<0.001)。机械取栓治疗MeVO的难题主要包括取栓器械、评估工具及相关技术经验等的缺乏。结论对MeVO的血管内治疗的方案存在较大的异质性,整体首选机械取栓的比例较低。Objective To investigate the propensity for mechanical thrombectomy for acute ischemic stroke with medium vessel occlusion(MeVO).Methods From January 2019 to January 2020,doctors from 150 tertiary hospitals in China capable of performing mechanical thrombectomy were selected as the survey subjects.Questionnaires from 131 physicians in 126 hospitals were collected for the study.Referring to the Advanced Live Interventional Course of Essen(ALICE),the research questionnaire was designed,and the questionnaire was collected by Sojump.The contents of the questionnaire included:(1)Information about the hospitals and doctors was interviewed.(2)Six cases of mild MeVO were designed(3 cases in each group with and without contraindications to alteplase thrombolysis),and each group included 1 case with occlusion at the M3 segment of the middle cerebral artery,1 cases with occlusion at the A2 segment of the anterior cerebral artery,and 1 case with occlusion at the P2 segment of the posterior cerebral artery.The treatment plan adopted by the interviewed doctors for 6 cases was investigated(immediate mechanical thrombectomy,refusal to perform mechanical thrombectomy,and mechanical thrombectomy after failure of thrombolysis).(3)Five typical MeVO cases with ages of 40-,50-,60-,70-,and≥80 years respectively were designed to investigate the treatment strategies for cases of different ages.(4)We investigated the difficulties of using mechanical thrombectomy for MeVO in clinical practice and relevant possible solutions.Results Among the 131 physicians,the proportion of physicians refusing mechanical thrombectomy in 6 cases was 30.5%(40)to 47.3%(62).For M3 segment occlusion without contraindications to thrombolysis,the proportion of physicians choosing immediate mechanical thrombectomy was 11.5%(15),that was 33.6%(44)and 29.8%(39)for A2 and P2 occlusion respectively,and the differences were significant(P<0.001).The proportion of physicians considering mechanical thrombectomy after failure of thrombolysis was 58.0%(76)for M3 segment o

关 键 词：脑缺血 急性病 问卷调查 中等血管闭塞 机械取栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]