TREVO支架取栓治疗超时间窗后循环缺血性脑卒中的疗效  

Efficacy of TREVO stent thrombectomy in the treatment of patients with posterior circulation ischemic stroke beyond the time window

作　　者：刘艳峰[1] 吴洁[2] 肖丽萍 周涛[1] LIU Yanfeng;WU Jie;XIAO Liping;ZHOU Tao(Handan First Hospital,Handan 056000,China;Handan Central Hospital,Handan 056000,China)

机构地区：[1]邯郸市第一医院,河北邯郸056000 [2]邯郸市中心医院,河北邯郸056000

出　　处：《中国实用神经疾病杂志》2022年第5期577-582,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河北省2019年度医学科学研究课题计划(编号:20190805)。

摘　　要：目的 探讨TREVO支架取栓对超时间窗后循环缺血性脑卒中(CIS)患者脑血流灌注及血清神经元特异性烯醇化酶(NSE)、基质金属蛋白酶9(MMP-9)、内皮型一氧化氮合酶(eNOS)水平的影响。方法 选取邯郸市第一医院收治的106例超时间窗后循环CIS患者为研究对象,观察组64例患者接受TREVO支架取栓治疗,对照组42例患者接受重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗。采用美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评价神经功能,检测闭塞区域的脑血流量(CBF)、平均通过时间(MTT)和达峰时间(TTP)以评价脑血流灌注状况,采用酶联免疫吸附法(ELISA)检测血清NSE、MMP-9、eNOS水平。比较2组治疗前后神经功能评分,脑血流动力学指标,血清NSE、MMP-9、eNOS水平及不良反应发生情况。结果 治疗后观察组NIHSS评分、mRS评分[分别为(4.62±1.74)分、(2.14±0.15)分]显著低于对照组[分别为(6.70±1.88)分、(2.47±0.41)分,P<0.05],CBF[(55.14±5.14) mL/(100 g·min)]显著高于对照组[(45.95±5.79) mL/(100 g·min),P<0.05],MTT、TTP[分别为(8.77±2.79)s、(21.37±7.73)s]显著短于对照组[分别为(11.17±3.14)s、(24.35±5.57)s,P<0.05]。观察组治疗7 d、14 d、30 d后NSE及MMP-9水平显著低于同期对照组,eNOS水平显著高于同期对照组(P<0.05)。观察组总不良反应发生率著低于对照组(29.69%vs 61.90%,P<0.05)。结论 TREVO支架取栓治疗可有效改善超时间窗后循环CIS患者的脑血流灌注状况,并可有效降低血清NSE、MMP-9水平,提高血清e NOS水平,利于患者神经功能的进一步恢复,防止缺血再灌注损伤,预防血栓复发。Objective To investigate the effects of TREVO stent thrombectomy on cerebral blood perfusion and the levels of serum neuron specific enolase(NSE),matrix metalloproteinase-9(MMP-9) and endothelial nitric oxide synthase(cNOS) in patients with posterior circulation ischemic stroke.Methods Totally106 patients with posterior circulation ischemic stroke beyond the time window treated in the First Hospital of Handan were selected as the research objects.Observation group of 64 patients receiving TREVO stent thrombectomy,and control group of 42 patients receiving recombinant tissue plasminogen activator(rt-PA)thrombolysis.The National Institutes of Health stroke scale(NIHSS) and modified Rankin Scale(MRS) were used to evaluate the neurological function of patients.The cerebral blood flow(CBF),mean transit time(MTT)and peak time(TTP) in the occluded area were measured to evaluate the cerebral blood flow perfusion.The levels of serum NSE,MMP-9 and eNOS were detected by enzyme-linked immunosorbent assay(ELISA).The neurological function score,cerebral hemodynamic indexes,serum NSE,MMP-9 and eNOS levels and the incidence of adverse reactions after treatment were compared and analyzed between the two groups before and after treatment.Results After treatment,NIHSS score,mRS score((4.62±1.74) points,(2.14±0.15) points) in the observation group were significantly lower than those in the control group((6.70±1.88) points,(2,47±0.41)points,P<0.05),CBF((55.14±5.14) mL/(100 g·min)) was significantly higher than that in the control.group((45.95±5.79) mL/(100 g·min),P<0.05),MTT and TTP((8.77±2.79) s,(21.37±7.73) s) were significantly shorter than those in the control group((11.17±3.14) s,(24.35±5.57) s,P<0.05).The levels of NSE and MMP-9 in the observation group after 7,14 and 30 days of treatment were significantly lower than those of the control group in the same periods.The levels of eNOS were significantly higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was

关 键 词：缺血性脑卒中 后循环缺血 机械取栓 TREVO支架 缺血再灌注损伤 神经元特异性烯醇化酶 基质金属蛋白酶9 内皮型一氧化氮合酶 血清 

分 类 号：R743.3[医药卫生—神经病学与精神病学]