亚低温治疗机械取栓血管再通后急性前循环大面积脑梗死的临床疗效分析  

Analysis of clinical effect of mild hypothermia on acute anterior circulation large area cerebral infarction after mechanical thrombolysis and recanalization

作　　者：高宏[1] 薛萌 焦晓园 高莉娜 刘世福[2] GAO Hong;XUE Meng;JIAO Xiao-yuan(Department of Medical Imaging,Huanghe Sanmenxia Hospital,Sanmenxia Henan 472000,China;Department of Neurology,Huanghe Sanmenxia Hospital,Sanmenxia Henan 472000,China)

机构地区：[1]黄河三门峡医院医学影像科,河南三门峡472000 [2]黄河三门峡医院神经内科,河南三门峡472000

出　　处：《临床和实验医学杂志》2025年第2期148-151,共4页Journal of Clinical and Experimental Medicine

基　　金：河南省医学科技攻关计划项目(编号:LHGj20200779)。

摘　　要：目的探讨亚低温治疗机械取栓血管再通后急性前循环大面积脑梗死的临床疗效。方法采用回顾性研究收集2019年1月至2024年2月黄河三门峡医院神经内科收治的32例机械取栓术后血管再通的急性前循环大面积脑梗死患者,采用亚低温治疗的患者为亚低温组,对照组采用除亚低温治疗外的常规治疗。比较两组患者治疗前及治疗后72 h、治疗后2周的美国国立卫生研究院卒中量表(NIHSS)评分、Bathel指数,利用多模态磁共振成像技术检测并比较两组间治疗前及治疗后72 h、治疗后2周的DWI参数表观弥散系数(ADC)、相对ADC值,并观察并比较两组患者治疗前及治疗后72 h、治疗后2周的血清S100-β、髓鞘碱性蛋白(MBP)水平。结果(1)两组治疗后72 h、治疗后2周的NIHSS评分均较治疗前下降,且亚低温组治疗后72 h、治疗后2周的NIHSS评分均低于对照组,差异均有统计学意义(P<0.05)。两组治疗后2周的Bathel指数均治疗前升高,且亚低温组治疗后72 h、治疗后2周的Bathel指数均高于对照组,差异均有统计学意义(P<0.05)。(2)亚低温组治疗后7 d、治疗后2周的患侧ADC、相对ADC均高于治疗前,对照组治疗后2周的患侧ADC、治疗后7 d、治疗后2周的相对ADC均高于治疗前,差异均有统计学意义(P<0.05);亚低温组治疗后7 d、治疗后2周的患侧ADC、相对ADC均高于对照组,差异均有统计学意义(P<0.05)。(3)两组治疗后72 h及治疗后2周的S100-β水平均较治疗前下降,差异均有统计学意义(P<0.05);两组治疗后72 h及治疗后2周的MBP水平与治疗前比较,差异均无统计学意义(P>0.05);亚低温组治疗后72 h及治疗后2周的S100-β、MBP水平均低于对照组,差异均有统计学意义(P<0.05)。结论机械取栓血栓再通后急性前循环大面积脑梗死患者联合亚低温治疗可有效改善患者神经功能及大脑供血情况,降低血清S100-β、MBP水平,促进神经功能恢复。Objective To investigate the clinical effect of mild hypothermia in patients with acute large hemispheric cerebral infarction after mechanical thrombectomy.Methods A retrospective study was conducted to evaluate 32 patients with acute anterior circulation massive cerebral infarction who underwent vascular recanalization after mechanical thrombectomy treated in the Department of Neurology of Huanghe Sanmenxia Hospital from January 2019 to February 2024.The patients treated with mild hypothermia were included in the mild hypothermia group,while the control group received conventional treatment except mild hypothermia.The National Institutes of Health Stroke Scale(NIHSS)score and Bathel index were compared between the two groups before treatment,72 hours after treatment and 2 weeks after treatment.The apparent diffusion coefficient(ADC)and relative ADC values of DWI parameters were detected and compared between the two groups before treatment,72 hours after treatment and 2 weeks after treatment by multimodal magnetic resonance imaging.The levels of serum S100-β and myelin basic protein(MBP)were observed and compared between the two groups before treatment,72 hours after treatment and 2 weeks after treatment.Results(1)The NIHSS scores of the two groups at 72 h and 2 weeks after treatment were lower than those before treatment,and the NIHSS scores of the mild hypothermia group at 72 h and 2 weeks after treatment were lower than those of the control group,the differences were statistically significant(P<0.05).The Bathel index of the two groups at 2 weeks after treatment increased before treatment,and the Bathel index of the mild hypothermia group at 72 hours and 2 weeks after treatment was higher than that of the control group,the differences were statistically significant(P<0.05).(2)The ADC value of the affected side and relative ADC value of the mild hypothermia group at 7 days after treatment and 2 weeks after treatment were higher than those before treatment,the ADC value of the affected side of the control group

关 键 词：急性脑梗死 亚低温 多模态磁共振成像 S100-Β蛋白 髓鞘碱性蛋白 

分 类 号：R74[医药卫生—神经病学与精神病学]