SWIM取栓技术在急性颅脑大血管闭塞治疗中的应用  

Application of SWIM thrombectomy technique in the treatment of acute craniocerebral great vessel occlusion

作　　者：胡月龙[1] 赵曙光[2] 杨国瑛[1] 崔涛[2] Hu Yuelong;Zhao Shuguang;Yang Guoying(Department of Neurosurgery,Taihe County People′s Hospital,Fuyang 236600,China)

机构地区：[1]太和县人民医院神经外科,阜阳236600 [2]太和县人民医院急诊医学科,阜阳236600

出　　处：《中华保健医学杂志》2024年第1期38-41,共4页Chinese Journal of Health Care and Medicine

基　　金：阜阳市自筹经费科技计划项目(FK202081078)。

摘　　要：目的研究颅内支撑导管辅助Solitaire支架取栓抽吸技术(SWIM)在急性颅脑大血管闭塞治疗中的效果。方法选取太和县人民医院2020年11月~2022年5月收治的90例急性颅脑大血管闭塞患者,采取随机数字表法分为观察组与对照组,各45例。观察组给予SWIM取栓术,对照组给予单纯支架取栓术。术后,采用脑梗死溶栓(TICI)治疗分级标准评估血管再通情况;分别于术前及术后1周采用美国国立卫生研究院卒中量表(NIHSS)评估神经缺损情况,Barthel量表评估患者日常生活自理能力;分别于术前及术后1周检测比较两组神经功能指标[神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、S100β蛋白(S100β)]水平;术后随访3个月,采用改良Rankin量表(mRs)评估患者预后,记录两组患者并发症和死亡情况。结果观察组血管再通率(95.56%,4345)明显高于对照组(68.89%,3145),差异有统计学意义(χ^(2)=10.946,P<0.05)。术后1周,观察组NIHSS评分、NSE、S100β水平较对照组低[(5.37±1.09)分vs.(6.24±1.22)分、(6.03±0.92)ng ml vs.(8.18±1.17)ng ml、(0.27±0.07)ng ml vs.(0.35±0.09)ng ml],观察组Barthel评分、BDNF水平较对照组高[(79.06±8.72)分vs.(69.14±8.09)分、(4776.51±508.65)pg ml vs.(4022.39±425.33)pg ml],差异有统计学意义(t=3.567、9.690、4.707、5.594、7.630,P<0.05)。术后3个月,观察组mRs评分低于对照组,差异有统计学意义(χ^(2)=5.344,P<0.05);两组并发症发生率和死亡率近似,差异无统计学意义(χ^(2)=0.549、0.714,P>0.05)。结论SWIM取栓术能够较好恢复急性颅脑大血管闭塞患者的血流灌注,改善其神经缺损,提高其生活自理能力,同时可改善患者预后。Objective To investigate the effect of Solitaire FR with intracranial support catheter for mechanical thrombectomy(SWIM)in the treatment of acute craniocerebral great vessel occlusion.Methods A total of 90 patients with acute craniocerebral great vessel occlusion admitted to our hospital from November 2020 to May 2022 were included in the study and divided into an observation group and a control group,with 45 cases in each group,by using random number table.The observation group received SWIM thrombectomy,while the control group underwent stent thrombectomy.Vascular recanalization was evaluated using thrombolysis in cerebral Infarction(TICI)treatment grading criteria after surgery.Preoperative and postoperative 1 week,we used National Institutes of Health Stroke Scale(NIHSS)to evaluate the neurological defects of the patients,and Barthel scale was used to assess the patients′self-care ability in daily life.The levels of neural function index[neuron-specific enolase(NSE),brain-derived neurotrophic factor(BDNF)and S100βprotein(S100β)]in the two groups were compared before and 1 week after surgery.Prognosis was assessed by the modified Rankin scale(mRs)3 months after surgery,with the complications and mortality recorded in both groups.Results The proportion of patients with the vascular revascularization rate in the observation group were significantly higher than those in the control group(χ^(2)=10.946,P<0.05).At 1 week after surgery,the NIHSS score in the observation group was lower than in the control group,and Barthel score in the observation group was higher than in the control group(t=3.567,5.594,P<0.05).Additionally,at 1 week after surgery,NSE and S100βlevels in the observation group were lower than in the control group,and BDNF levels in the observation group were higher than in the control group(t=9.690,4.707,7.630,P<0.05).Complication rates were similar between the two groups(P>0.05).The mRs score of the observation group was lower than that of the control group 3 months after operation(P<0.05).There

关 键 词：急性颅脑大血管闭塞 机械取栓 颅内支撑导管 血管再通 

分 类 号：R743[医药卫生—神经病学与精神病学]