不同时间窗支架取栓对前循环急性脑梗死患者的治疗效果分析  

The therapeutic effect of stent thrombectomy at different time windows on patients with acute cerebral infarction in the anterior circulation

作　　者：孙炎 孔维丹 王刚[1] 刘宏娜 SUN Yan;KONG Weidan;WANG Gang;LIU Hongna(Department of Neurology,the First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院神经内科,河北张家口075000

出　　处：《江苏大学学报（医学版）》2024年第5期428-432,455,共6页Journal of Jiangsu University：Medicine Edition

基　　金：河北省2022年度医学科学研究课题(20220590)。

摘　　要：目的:探讨不同时间窗支架取栓对前循环急性脑梗死患者的治疗效果。方法:选择2020年1月至2022年12月河北北方学院附属第一医院神经内科收治的193例前循环急性脑梗死患者,根据发病至接受支架取栓的治疗时间,将其分为≤3.0 h组(n=75)、3.0~4.5 h组(n=48)、4.6~6.0 h组(n=70),分别于发病后≤3.0 h、3.0~4.5 h、4.6~6.0 h接受支架取栓治疗。治疗前和治疗14 d采用美国国立卫生研究院卒中量表(NIHSS)和Alberta卒中项目早期CT(ASPECT)评分评估患者病情严重程度;治疗7、21 d采用简易智力状态检查量表(MMSE)和蒙特利尔认知评估(MoCA)量表评估患者的认知功能;在治疗前及治疗3、7 d,采用ELISA法检测血清中IL-4、超敏C反应蛋白(hs-CRP)和高迁移率族蛋白B1(HMGB1)含量;治疗90 d,采用改良Rankin量表(mRS)评估患者预后。结果:治疗14 d,与≤3.0 h组相比,3.0~4.5 h组及4.6~6.0 h组NIHSS评分显著升高(P<0.05),ASPECT评分显著降低(P<0.05);治疗7、21 d,与≤3.0 h组相比,3.0~4.5 h组和4.6~6.0 h组MMSE和MoCA评分显著降低(P<0.05);治疗3、7 d,与≤3.0 h组相比,3.0~4.5 h组和4.6~6.0 h组IL-4、hs-CRP和HMGB1含量显著升高(P<0.05);治疗90 d,与≤3.0 h组相比,3.0~4.5 h组和4.6~6.0 h组mRS≤2分占比明显降低(P<0.05),3.0~4.5 h组与4.6~6.0 h组相比差异无统计学意义(P>0.05)。结论:前循环急性脑梗死患者越早(发病后≤3.0 h)进行支架取栓,临床疗效越好,神经功能恢复也越好。Objective:To evaluate the therapeutic effect of stent thrombectomy at different time windows on patients with acute cerebral infarction in the anterior circulation.Methods:A total of 193 patients with acute cerebral infarction in the anterior circulation were chosen,who were admitted to the Department of Neurology of the First Affiliated Hospital of Hebei North University from January 2020 to December 2022.The patients were divided into≤3.0 h group(n=75),3.0-4.5 h group(n=48),and 4.6-6.0 h group(n=70)based on the time from onset to receiving stent thrombus removal treatment.The patients were treated with stent thrombectomy≤3.0 h,3.0-4.5 h,and 4.6-6.0 h after onset,respectively.The National Institutes of Health Stroke Scale(NIHSS)and Alberta Stroke Program Early CT(ASPECT)Score were used to assess the severity of patient′s conditions before and 14 days after treatment.After 7 and 21 days of treatment,the patient′s cognitive function was evaluated by the Mini Mental State Examination(MMSE)and Montreal Cognitive Assessment Scale(MoCA).The contents of IL-4,hypersensitive C-reactive protein(hs-CRP)and high mobility group box-1 protein(HMGB1)in serum were detected by ELISA before treatment and 3,7 days after treatment.After 90 days of treatment,the prognosis of the patients was assessed by using the modified Rankin Scale(mRS).Results:After 14 days of treatment,compared with≤3.0 h group,the NIHSS score in 3.0-4.5 h group and 4.6-6.0 h group significantly increased(P<0.05),while the ASPECT score greatly decreased(P<0.05).At 7 and 21 days after treatment,compared with≤3.0 h group,the MMSE and MoCA scores in 3.0-4.5 h and 4.6-6.0 h groups were significantly reduced(P<0.05).At 3 and 7 days after treatment,compared with≤3.0 h group,the IL-4,hs-CRP,and HMGB1 levels significantly increased in the 3.0-4.5h group and the 4.6-6.0 h group(P<0.05).After 90 days of treatment,compared with the≤3.0 h group,the proportion of mRS≤2 points in the 3.0-4.5 h group and the 4.6-6.0 h group was significantly decreased(P<0.05

关 键 词：前循环 急性脑梗死 支架取栓 时间窗 

分 类 号：R743.33[医药卫生—神经病学与精神病学]