静脉溶栓联合Solitaire FR型支架取栓术对急性大动脉闭塞性脑梗死患者的疗效分析  

Efficacy of intravenous thrombolysis combined with Solitaire FR stent thrombectomy in treatment of acute LAO cerebral infarction

作　　者：王鹏 文洪波 黄健康 邹荣成 丁洁[1] 汪捷 舒永伟 丁朋雨 Wang Peng;Wen Hongbo;Huang Jiankang;Zou Rongcheng;Ding Jie;Wang Jie;Shu Yongwei;Ding Pengyu(Department of Neurology,Lishui District People's Hospital/Lishui Branch of Zhongda Hospital Affiliated to Southeast University,Nanjing 211200,Jiangsu Province,China)

机构地区：[1]南京市溧水区人民医院(东南大学附属中大医院溧水分院)神经内科,211200

出　　处：《中华老年心脑血管病杂志》2024年第1期67-70,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：南京市溧水区人民医院2021年度引进人才科研启动基金项目(2021YJ09)。

摘　　要：目的探究静脉溶栓联合Solitaire FR型支架取栓术对急性大动脉闭塞性脑梗死患者血管再通、神经功能的影响及预后分析。方法回顾性选取2020年10月至2023年3月南京市溧水区人民医院收治的急性大动脉闭塞性脑梗死患者172例,根据治疗方法分为对照组和研究组,每组86例,对照组采用阿替普酶静脉溶栓治疗,研究组采用阿替普酶静脉溶栓联合Solitaire FR型支架取栓术治疗。比较2组血管再通、神经功能、脑血流灌注和不良事件情况,随访90 d采用改良Rankin量表评价预后。结果2组成功再通率比较,差异无统计学意义(P>0.05),研究组完全再通率高于对照组(68.60%vs 50.00%,P<0.05)。治疗后7 d、14 d,研究组美国国立卫生研究院卒中量表评分低于对照组,差异有统计学意义(P<0.01)。治疗后,研究组脑血容量、脑血流量高于对照组,平均通过时间低于对照组,差异有统计学意义(P<0.05,P<0.01);2组治疗期间不良事件总发生率比较,差异无统计学意义(P>0.05)。随访90 d,研究组良好预后比例高于对照组(80.23%vs 63.95%,P<0.05)。结论静脉溶栓联合Solitaire FR型支架取栓术在急性大动脉闭塞性脑梗死中效果较好,血管再通效果理想,可明显改善患者神经功能和预后。Objective To explore the effects of intravenous thrombolysis combined with Solitaire FR stent thrombectomy on vascular recanalization,neurologic function and prognosis in patients with acute cerebral infarction(ACI)due to large artery occlusion(LAO).Methods A total of 172 patients with ACI-LAO treated in our department between October 2020 and March 2023 were retrospectively enrolled.According to treatment regimens,they were assigned into control group(86 cases,alteplase intravenous thrombolysis)and study group(86 cases,alteplase intravenous thrombolysis combined with Solitaire FR stent thrombectomy).Vascular recanalization,neurologic function,cerebral perfusion and occurrence of adverse events were compared between the two groups.After 90 d of follow-up,their prognosis was evaluated with modified Rankin scale.ResultsThere was no significant difference in success rate of vascular recanalization between the two group(P>0.05),but complete recanalization rate was statistically higher in the study group than the control group(68.60%vs 50.00%,P<0.05).The study group had obviously lower NHISS scores at 7 and 14 d after treatment,higher cerebral blood volume and cerebral blood flow,but shorter mean transit time when compared with the control group(P<0.05,P<0.01).No notable difference was observed in the total incidence of adverse events between them(P>0.05).After 90 d of follow-up,the proportion of good prognosis was higher in the study group than the control group(80.23%vs 63.95%,P<0.05).Conclusion Intravenous thrombolysis combined with Solitaire FR stent thrombectomy shows better efficacy in ACI-LAO patients,with better vascular recanalization and great improvements in neurologic function and prognosis.

关 键 词：脑梗死 栓子清除术 纤维蛋白溶解药 组织型纤溶酶原激活物 预后 Solitaire FR型支架 

分 类 号：R743.33[医药卫生—神经病学与精神病学]