多模式影像指导超时间窗急性大血管闭塞性脑卒中血管内再灌注治疗的应用研究  

Application study of multimodal imaging in guiding endovascular reperfusion therapy for acute large vessel occlusive stroke beyond time window

作　　者：陈昕[1] 吴光亮 徐德辉 张现伟[1] 赵晶[1] 陈豪选 林浩 CHEN Xin;WU Guangliang;XU Dehui;ZHANG Xianwei;ZHAO Jing;CHEN Haoxuan;LIN Hao(Department of Encephalopathy,Guangdong Provincial Hospital of Chinese Medicine,Zhuhai,Guangdong Province,Zhuhai 519015,China;Department of Encephalopathy,the Second Clinical Medical College of Guangzhou University of Chinese Medicine(Guangdong Provincial Hospital of Traditional Chinese Medicine),Guangdong Province,Guangzhou 510120,China)

机构地区：[1]广东省中医院珠海医院脑病科,广东珠海519015 [2]广州中医药大学第二临床医学院(广东省中医院)脑病大科,广东广州510120

出　　处：《中国当代医药》2024年第23期16-21,共6页China Modern Medicine

基　　金：广东省科技创新战略专项资金(省重点实验室评估运行经费)项目(2023B1212060062);广东省珠海市卫生健康局医学科研基金项目(ZH24013310210009PWC、ZH24013310210008PWC、2420009000103)。

摘　　要：目的探讨超时间窗急性大血管闭塞所致的缺血性脑卒中患者经严格影像学评估后行急诊绿色通道血管内再灌注治疗的安全性和有效性。方法选取2021年1月至2022年12月在广东省中医院珠海医院救治的急性大血管狭窄或闭塞所致的缺血性脑卒中并经影像学评估存在缺血半暗带和侧支循环的36例患者作为研究对象,采用抽签法将36例患者分为观察组(19例)与对照组(17例)。观察组接受血管内有效再灌注治疗,对照组接受标准内科药物治疗。比较两组患者入院时、出院时、出院3个月的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分,比较两组患者出院3个月后良好临床结局,以及治疗30 d内脑卒中、症状性脑出血、死亡的发生率。结果观察组患者出院时、出院后3个月的NIHSS评分低于对照组,差异有统计学意义(P<0.05);观察组患者出院时、出院后3个月的NIHSS评分低于本组入院时的评分,差异有统计学意义(P<0.05)。观察组患者出院时、出院后3个月的mRS评分均低于对照组,差异有统计学意义(P<0.05);观察组患者出院时、出院后3个月的mRS评分均低于本组入院时,差异有统计学意义(P<0.05)。出院后3个月,观察组的良好临床结局率高于对照组,差异有统计学意义(P<0.05)。治疗30 d内,两组患者的脑卒中、症状性脑出血、死亡率比较,差异无统计学意义(P>0.05)。结论超时间窗急性大血管闭塞所致的缺血性脑卒中患者经严格影像学评估后急诊行血管内再灌注治疗可能是安全有效的。Objective To explore the safety and effectiveness of emergency green channel intravascular reperfusion therapy in patients with ischemic stroke caused by acute large vessel occlusion beyond the time window after strict imaging evaluation.Methods A total of 36 patients with acute ischemic stroke caused by large vessel stenosis or occlusion treated at Guangdong Provincial Hospital of Chinese Medicine,Zhuhai,from January 2021 to December 2022,who were assessed by imaging to have ischemic penumbra and collateral circulation.The 36 patients were divided into observation group(19 cases)and control group(17 cases)by drawing lots.The observation group received endovascular effective reperfusion therapy,while the control group accepted standard internal medicine medications.The National Institute of Health stroke scale(NIHSS)score and modified Rankin scale(mRS)score at admission,discharge,and 3 months after discharge were compared between the two groups.The good clinical outcome 3 months after discharge,and the incidence of stroke,symptomatic cerebral hemorrhage,and death within 30 days of treatment were compared between the two groups.Results The NIHSS score of observation group at discharge and 3 months after discharge were lower than those of control group,and the differences were statistically significant(P<0.05).The NIHSS scores of the observation group at discharge and 3 months after discharge were lower than those at admission,and the differences were statistically significant(P<0.05).The mRS scores in the observation group at discharge and 3 months after discharge were lower than those in the control group,with statistically significant differences(P<0.05).The mRS scores in the observation group at discharge and 3 months after discharge were lower than those at admission,and the differences were statistically significant(P<0.05).Three months after discharge,the good clinical outcome rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).With

关 键 词：急性缺血性脑卒中 影像学评估 缺血半暗带 血管内再灌注治疗 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]