大核心梗死的急性前循环缺血性卒中患者血管内治疗的疗效观察  

Endovascular treatment for acute anterior circulation ischemic stroke with large core infarct

作　　者：穆珊珊[1] 李弘 刘泽民[1] 王洋[1] 张凤莲[1] 王彦[1] MUShanshan;LI Hong;LIU Zemin;WANG Yang;ZHANG Fenglian;WANG Yan(Chief Physician,,Department of Neurology,Tangshan People's Hospital,Tangshan063000,China)

机构地区：[1]河北省唐山市人民医院神经内一科,063000

出　　处：《中国煤炭工业医学杂志》2023年第4期366-370,共5页Chinese Journal of Coal Industry Medicine

基　　金：河北省医学科学研究课题(编号:20231804)。

摘　　要：目的观察大核心梗死的急性前循环缺血性卒中患者血管内治疗术后的疗效。方法回顾性收集2019年12月—2021年12月唐山市人民医院神经内一科收治的发病时间在24小时内的急性前循环缺血性卒中合并大血管狭窄或闭塞,且ASPECTS评分介于3~5分的患者,采用美国国立卫生研究院卒中量表(National IstituteofHealthStrokeScalen,NIHSS)评估神经功能缺损改善情况,采用改良Rankin量表(m odifiedRankinScale,m RS)评分评估90d预后情况,并记录相关并发症及病死率以评价预后。结果纳入并完成随访的65例患者中,血管内治疗组28例,常规治疗组37例。血管内治疗组患者治疗48h、7d、14d后,NIHSS评分逐渐降低,与常规治疗组相比,评分显著降低(P<0.05);血管内治疗组患者90dmRS评分0~3分的比例显著高于常规治疗组(P<0.05);症状性颅内出血的发生率、行去骨瓣减压手术率以及90d病死率,二组相比无统计学差异(P>0.05)。结论对于大核心梗死的急性前循环缺血性卒中,合并大血管狭窄或闭塞的患者,血管内治疗能改善患者的神经功能预后,且不增加症状性颅内出血的风险,血管内治疗可能是安全有效的。Objective To observe the efficacy of endovascular treatment in patients with acute anterior circulatory ischemic stroke with large core infarction. Methods Patients with acute anterior circulation ischemic stroke with large vessel stenosis or occlusion within 24 hours of onset and ASPECTS score between 3-5 were retrospectively collected from the First Department of Neurology, Tangshan People's Hospital from December 2019 to December 2021.By the national institutes of health stroke scale(National Institute of Health Stroke Scale, NIHSS) assessment to improve neurologic deficits, The modified Rankin Scale(mRS) score was used to evaluate the 90d prognosis, and related complications and mortality were recorded to evaluate the prognosis. Results Among the Sixty-five patients who were included and completed follow-up, 28 patients were in endovascular treatment group and 37 patients were in conventional treatment group.After 48 hours, 7 days and 14 days of treatment, the NIHSS score of patients in endovascular treatment group was gradually decreased, which was significantly lower than that in conventional treatment group(P<0.05).The proportion of 90dmRS score 0-3 in endovascular treatment group was significantly higher than that in conventional treatment group(P<0.05).There were no significant differences in the incidence of symptomatic intracranial hemorrhage, decompressive craniectomy and 90-day mortality between the two groups(P>0.05). Conclusion For patients with acute anterior circulation ischemic stroke with large core infarction and large vessel stenosis or occlusion, vascular reperfusion therapy can improve the neurological prognosis of patients without increasing the risk of symptomatic intracranial hemorrhage.Endovascular therapy may be safe and effective.

关 键 词：大核心梗死 急性前循环缺血性卒中 血管内治疗 

分 类 号：R54[医药卫生—心血管疾病]