桥接治疗急性缺血性脑卒中患者的血管再通率及远期神经功能恢复分析
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摘要
目的探讨重组组织型纤溶酶原激活物(rtPA)静脉溶栓联合血管内介入治疗(即桥接治疗法)对急性缺血性脑卒中患者的治疗效果。方法选取我院(2015年1月-2018年1月)收治的100例急性缺血性脑卒中患者进行回顾性分析,根据治疗方法分为观察组47例(桥接治疗法)、对照组53例(rtPA静脉溶栓疗法),对比两组治疗后的血管再通率、神经功能恢复情况。结果观察组前循环梗死血管(颈内动脉、大脑前动脉、大脑中动脉)再通率91.49%,对照组前循环梗死血管再通率50.94%,两组比较差异具有统计学意义(P<0.01);观察组治疗14 d、治疗28 d、治疗3个月,神经功能缺损(NIHSS)评分均显著的低于对照组(P<0.01);根据mRS标准,观察组的预后良好87.23%,对照组预后良好52.83%,两组比较差异具有统计学意义(P<0.01);观察组的并发症发生率8.51%,对照组并发症发生率16.98%,两组比较差异无统计学意义(P>0.05)。结论桥接治疗对缺血性脑卒中患者的效果优于rtPA静脉溶栓疗法,对于患者远期神经功能恢复具有显著效果。
Objective To investigate the therapeutic effect of intravenous thrombolysis with recombinant tissue plasminogen activator(rtPA) combined with endovascular therapy(bridging therapy) in patients with acute ischemic stroke. Methods One hundred patients with acute ischemic stroke admitted to our hospital from January 2015 to January 2018 were analyzed retrospectively. According to the therapies received, 47 cases were assigned to observation group(treated with bridging therapy), and53 patients to control group(treated with rtPA thrombolytic therapy). The revascularization rate and recovery of neurological function after treatment were compared between the two groups. Results There was a significant difference in the revascularization rate of anterior circulation infarction(internal carotid artery, anterior cerebral artery, and middle cerebral artery) between the observation group and the control group(P<0.01). The National Institutes of Health Stroke Scale score in the observation group was significantly lower than that in the control group on days 14 and 28 and at month 3 of treatment(P <0.01). According to the modified Rankin Scale standard, the good prognosis rate was significantly different between the observation group and the control group(P<0.01). The complication rates in the observation group and the control group were 8.51% and 16.98%, respectively,with no significant difference(P>0.05). Conclusion Bridging therapy has a superior clinical effect to intravenous thrombolysis with rtP A in patients with ischemic stroke, and it has a significant effect in promoting recovery of neurological function.
Objective To investigate the therapeutic effect of intravenous thrombolysis with recombinant tissue plasminogen activator(rtPA) combined with endovascular therapy(bridging therapy) in patients with acute ischemic stroke. Methods One hundred patients with acute ischemic stroke admitted to our hospital from January 2015 to January 2018 were analyzed retrospectively. According to the therapies received, 47 cases were assigned to observation group(treated with bridging therapy), and53 patients to control group(treated with rtPA thrombolytic therapy). The revascularization rate and recovery of neurological function after treatment were compared between the two groups. Results There was a significant difference in the revascularization rate of anterior circulation infarction(internal carotid artery, anterior cerebral artery, and middle cerebral artery) between the observation group and the control group(P<0.01). The National Institutes of Health Stroke Scale score in the observation group was significantly lower than that in the control group on days 14 and 28 and at month 3 of treatment(P <0.01). According to the modified Rankin Scale standard, the good prognosis rate was significantly different between the observation group and the control group(P<0.01). The complication rates in the observation group and the control group were 8.51% and 16.98%, respectively,with no significant difference(P>0.05). Conclusion Bridging therapy has a superior clinical effect to intravenous thrombolysis with rtP A in patients with ischemic stroke, and it has a significant effect in promoting recovery of neurological function.
引文
[1]王鹏,赵旭.CT灌注指导下尿激酶动脉溶栓治疗6~9h急性脑梗死的疗效[J].中国实用神经疾病杂志,2015,18(5):64-65.
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[5]陈向林,胡扬真,毛振敏,等.急性缺血性脑卒中超早期选择性动脉溶栓21例临床分析[J].中国医师杂志,2014,16(7):996-998.
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[8]曹洁,彭亚,宣井岗,等.Solitaire支架血管内治疗院内急性缺血性卒中[J].临床神经外科杂志,2015,20(6):442-444,448.
[9]王思思,白青科,赵振国,等.磁共振指导的急性缺血性脑卒中合并房颤患者溶栓治疗及预后的相关分析[J].卒中与神经疾病,2015,22(4):240-242.
[10] LANGE M C, BRUCHTP, PEDROZO J C, et al. The use of neurovascularultrasound versus digital subtraction angiography in acute ischemic stroke[J]. ArqNeuropsiquitra,2015,73(3):218-222.
[11]吴海琴,任宏伟,王虎清,等.动脉溶栓联合血管支架成形术治疗急性脑梗死患者的疗效观察[J].卒中与神经疾病,2015,22(5):268-272.
[12]蔡学礼,邱伟文,程伟进,等.超选择动脉内溶栓联合支架成形术治疗急性脑梗死[J].中国医师杂志,2014,16(8):1104-1106.
[13]丁晓东,孙鹏,张勇,等.脑梗死患者同侧颈动脉颅外段狭窄的血管内治疗[J].中华神经创伤外科电子杂志,2015,1(3):24-29.
[14] KAESMACHER J, KLEINE J F. Bridging therapy with i. v. rtPA in MCA occlusion prior to endovascular thrombectomy:a double-edged sword[J]. Clinical Neuroradiology, 2018,28(1):81-89.
[15]李子付,洪波,张永巍,等.远端滤网保护伞在症状性颈内动脉闭塞血管内再通治疗中的应用[J].中华神经外科杂志,2015,31(1):1-6.
[16] WEBER R, NORDMEYER H, HADISURYA J, et al. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis[J]. J Neurointerv Surg,2017,9(3):229-233.
[17]李生,吕斌.再审视颈动脉粥样硬化性狭窄血管内治疗中的几个问题[J].中华老年心脑血管病杂志,2015,17(11):1121-1124.
[2] GOYAL M, DEMCHUK A M, MENON B K, et al. Randomizedassessmentof rapid endovascular treatment of ischemic stroke[J]. N Engl J Med,2015,372(11):1019-1030.
[3]中华预防医学会卒中预防与控制专业委员会介入学组,急性缺血性脑卒中血管内治疗中国专家共识组.急性缺血性脑卒中血管内治疗中国专家共识[J].中国脑血管病杂志,2014,11(10):556-560.
[4]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]陈向林,胡扬真,毛振敏,等.急性缺血性脑卒中超早期选择性动脉溶栓21例临床分析[J].中国医师杂志,2014,16(7):996-998.
[6]周德生.脑的内景与神经功能解剖的相关性[J].湖南中医药大学学报,2016,36(10):1-4.
[7] CAMPBELL B C, MITCHELL P J, KLEINIG T J, et al. Endovascular therapy forischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372(11):1009-1018.
[8]曹洁,彭亚,宣井岗,等.Solitaire支架血管内治疗院内急性缺血性卒中[J].临床神经外科杂志,2015,20(6):442-444,448.
[9]王思思,白青科,赵振国,等.磁共振指导的急性缺血性脑卒中合并房颤患者溶栓治疗及预后的相关分析[J].卒中与神经疾病,2015,22(4):240-242.
[10] LANGE M C, BRUCHTP, PEDROZO J C, et al. The use of neurovascularultrasound versus digital subtraction angiography in acute ischemic stroke[J]. ArqNeuropsiquitra,2015,73(3):218-222.
[11]吴海琴,任宏伟,王虎清,等.动脉溶栓联合血管支架成形术治疗急性脑梗死患者的疗效观察[J].卒中与神经疾病,2015,22(5):268-272.
[12]蔡学礼,邱伟文,程伟进,等.超选择动脉内溶栓联合支架成形术治疗急性脑梗死[J].中国医师杂志,2014,16(8):1104-1106.
[13]丁晓东,孙鹏,张勇,等.脑梗死患者同侧颈动脉颅外段狭窄的血管内治疗[J].中华神经创伤外科电子杂志,2015,1(3):24-29.
[14] KAESMACHER J, KLEINE J F. Bridging therapy with i. v. rtPA in MCA occlusion prior to endovascular thrombectomy:a double-edged sword[J]. Clinical Neuroradiology, 2018,28(1):81-89.
[15]李子付,洪波,张永巍,等.远端滤网保护伞在症状性颈内动脉闭塞血管内再通治疗中的应用[J].中华神经外科杂志,2015,31(1):1-6.
[16] WEBER R, NORDMEYER H, HADISURYA J, et al. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis[J]. J Neurointerv Surg,2017,9(3):229-233.
[17]李生,吕斌.再审视颈动脉粥样硬化性狭窄血管内治疗中的几个问题[J].中华老年心脑血管病杂志,2015,17(11):1121-1124.