单纯球囊扩张术治疗急性大动脉闭塞性脑梗死的疗效研究  

Efficacy and safety of simple balloon dilatation for acute ischemic stroke patients with large artery occlusion

作　　者：夏文卿 卜香叶 阮婕 蒋琳[1] 牛国忠[1] 殷聪国[1] XIA Wenqing;BU Xiangye;RUAN Jie;JIANG Lin;NIU Guozhong;YIN Congguo(Department of Neurology,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院神经内科,310006

出　　处：《浙江医学》2022年第5期474-479,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科研项目(2021KY849);浙江省中医药科技计划项目(2021ZQ074);杭州市农业与社会发展科研一般项目(20201203B185);杭州市医药卫生科技计划项目(20200175)。

摘　　要：目的探讨合并颅内动脉粥样硬化(ICAS)的急性大动脉闭塞性脑梗死患者行单纯球囊扩张术的有效性及安全性,分析影响患者预后的相关因素。方法选择2016年4月至2020年9月在浙江大学医学院附属杭州市第一人民医院接受球囊扩张术且合并ICAS的急性大动脉闭塞性脑梗死患者76例。根据是否行补救性支架植入术,分为单纯球囊术扩张组47例,补救性支架植入术组29例,比较两组患者的一般资料、血管再通率、颅内出血(ICH)发生率、症状性颅内出血(sICH)发生率和90 d预后。单纯球囊扩张术组根据90 d预后情况,分为预后良好亚组和预后不良亚组,对预后不良危险因素进行多因素logistic回归分析。结果单纯球囊扩张术组与补救性支架植入术组之间血管再通率(97.8%比100%)、90 d预后良好率(57.4%比48.3%),sICH发生率(6.4%比6.9%)和90d死亡率(12.8%比10.3%)比较,差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示:ICH是影响单纯球囊扩张术治疗急性大动脉闭塞性脑梗死预后的独立危险因素。结论单纯球囊扩张术可以改善大动脉闭塞性脑梗死患者的功能性预后,不增加sICH发生率和死亡率。ICH可能是影响单纯球囊扩张术治疗急性大动脉闭塞性脑梗死预后的独立危险因素。Objective To investigate the efficacy and safety of simple balloon dilatation in the treatment of acute cerebral infarction with large artery occlusion.Methods Clinical data of 76 patients with acute large artery occlusion cerebral infarction who underwent balloon dilatation treatment in Hangzhou First People's Hospital from April 2016 to September 2020 were retrospectively analyzed.Among them 47 patients received simple balloon dilatation(balloon dilatation group)and 29 patients also received rescue stenting(rescue stenting group).The demographic data,recanalization rate,symptomatic intracranial hemorrhage(sICH)and clinical efficacy after 90 days were compared between the two groups.According to the 90 days clinical efficacy,patients with simple balloon dilatation were divided into good prognosis group and poor prognosis group,and the related factors affecting the prognosis of patients were analyzed by multivariate logistic regression analysis.Results The recanalization rate(97.8%vs.100%)and 90 days good prognosis(57.4%vs.48.3%)were similar between the balloon dilatation group and the rescue stenting group.There was no significant difference in sICH(6.4%vs.6.9%)and 90 days mortality(12.8%vs.10.3%).There were significant differences in age,location of vascular occlusion and times of balloon dilatation between the two groups(P<0.05).Multivariate logistic regression analysis showed that intracerebral hemorrhage(ICH)was an independent risk factor affecting the prognosis of simple balloon dilatation in the treatment of acute large artery occlusion cerebral infarction.Conclusion Simple balloon dilatation can improve the functional prognosis of patients with large artery occlusion cerebral infarction without increasing sICH and mortality.ICH is an independent risk factor affecting the prognosis of simple balloon dilatation in the treatment of acute large artery occlusion cerebral infarction.

关 键 词：脑梗死 球囊扩张术 机械取栓 脑出血 

分 类 号：R651.1[医药卫生—外科学]