远端通路导管取栓治疗早期急性脑梗死临床观察  

Clinical observation of distal access catheter thrombectomy in the treatment of early acute cerebral infarction

作　　者：王韬涛 孟清琳 潘娜 苟英之 WANG Taotao;MENG Qinglin;PAN Na;GOU Yingzhi(Air Force 986th Hospital of Air Force Military Medical University,Xi’an 710054,China)

机构地区：[1]空军军医大学空军第九八六医院,陕西西安710054

出　　处：《中国实用神经疾病杂志》2024年第10期1206-1211,共6页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省教育厅2020年度科学研究计划项目(编号:20JK0887)。

摘　　要：目的观察远端通路导管取栓治疗早期急性脑梗死(ACI)的临床效果及预后情况。方法选取2019-05—2023-11空军第九八六医院收治的120例早期ACI患者为研究对象,对照组(n=68)采用支架取栓治疗,研究组(n=52)采取远端通路导管取栓治疗。比较2组手术相关指征、神经功能情况(NIHSS评分)、神经损伤因子水平[神经元特异性烯醇化酶(NSE)、基质金属蛋白酶-9(MMP-9)、中枢神经特异性蛋白β(S-100β)]、血管再通情况[改良的脑梗死溶栓分级(mTICI)]、临床预后[改良Rankin量表(mRS)评分]以及并发症发生情况。结果研究组血管再通时间[(62.36±9.03)min]短于对照组[(55.97±11.35)min](P<0.05),一次取栓成功率(78.85%)高于对照组(57.35%,P<0.05)。2组术后7 d的NIHSS评分及NSE、MMP-9、S-100β水平均较术前降低,研究组均低于对照组(P<0.05)。研究组mTICI分级优于对照组,预后良好(mRS≤2分)率(82.69%)高于对照组(67.65%,P<0.05)。对照组病死率2.94%,研究组为1.92%,2组比较无统计学差异(P>0.05)。对照组并发症总发生率20.59%,研究组为13.46%,2组比较无统计学差异(P>0.05)。结论相较于支架取栓,远端通路导管取栓治疗早期ACI患者的一次取栓成功率高,同时能缩短取栓时间,改善患者神经功能,血管再通成功率高,患者预后良好,具有较高的安全性。Objective To observe the clinical effect and prognosis of distal access catheter thrombectomy in the treatment of early acute cerebral infarction(ACI).Methods Totally 120 patients with early ACI in the Air Force 986th Hospital from May 2019 to November 2023 were selected as the research subjects.The control group(n=68)was treated by stent thrombectomy,and the study group(n=52)was treated by distal access catheter thrombectomy.The surgery-related indications,neurological function(NIHSS score),nerve injury factors levels(neuron-specific enolase(NSE),matrix metalloproteinase-9(MMP-9),central nervous system specific proteinβ(S-100β)),vascular recanalization status(modified thrombolysis in cerebral infarction(mTICI)),clinical prognosis(modified Rankin scale(mRS))and complications were compared between the two groups.Results The vascular recanalization time in study group was shorter than that in control group((62.36±9.03)min vs(55.97±11.35)min,P<0.05),and the success rate of one-time thrombectomy was higher than that in control group(78.85%vs 57.35%,P<0.05).The NIHSS score and levels of NSE,MMP-9 and S-100βwere declined in the two groups,and the study group was lower than the control group(P<0.05).The mTICI grading was better in study group than that in control group,and the rate of good prognosis(mRS≤2)was higher than that in control group(82.69%vs 67.65%,P<0.05).The mortality rate was 2.94%in control group and 1.92%in study group,there was no significant difference between the two groups(P>0.05).The total incidence rate of complications was 20.59%in control group and that in study group was 13.46%,there was no significant difference between the two groups(P>0.05).Conclusion Compared with stent thrombectomy,distal access catheter thrombectomy has a high success rate of one-time thrombectomy in the treatment of early ACI patients.At the same time,it can shorten the time of thrombectomy,improve the neurological function of patients,and has high success rate of vascular recanalization,good prognosis and safety.

关 键 词：急性脑梗死 远端通路导管 导管取栓 支架取栓 预后 血管再通 

分 类 号：R743.33[医药卫生—神经病学与精神病学]