支架机械取栓与动脉溶栓对中重度急性脑梗死患者血管再通、神经功能及预后的影响研究
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摘要
目的分析支架机械取栓与动脉溶栓对中重度急性脑梗死(acute cerebral infarction,ACI)患者血管再通、神经功能及预后的影响。方法选取衡水市第六医院2015年1月—2017年2月收治的116例中重度ACI患者,按照治疗方式的不同分为研究组与对照组各58例,对照组患者给予动脉溶栓治疗,研究组患者给予支架机械取栓治疗。观察分析两组患者术后血管再通率,术前及术后第1、7天简明精神状态量表(mini-mental state examination,MMSE)评分,术后24 h出血率和术前及术后3、6个月改良Rankin量表评分(modified rankin scale,mRS)。结果研究组患者术后血管再通率为84.48%明显高于对照组的63.79%,差异有统计学意义(P<0.01)。术后第1、7天,两组患者MMSE评分均高于术前1 d,且研究组患者MMSE评分亦明显高于对照组患者,差异均有统计学意义(P<0.05或P<0.01)。研究组患者术后24 h出血率为5.17%明显低于对照组患者的22.41%,差异有统计学意义(P<0.01)。术后3、6个月,两组患者mRS评分均明显低于术前,且研究组患者mRS评分明显低于对照组患者,差异均有统计学意义(P<0.05或P<0.01)。结论中重度ACI患者应用支架机械取栓可以早期快速清除病变血管血栓,恢复血流灌注,增加血管再通率,且术后出血并发症发生率较低,安全性较好,对患者术后神经功能的恢复有积极意义。
Objective To analyze the effects of stent retriever-based thrombectomy(SRT) and arterial thrombolysis on revascularization,neurological function and bleeding in patients with moderate to severe acute cerebral infarction(ACI).Methods A total of 116 patients with moderate to severe ACI admitted to Sixth Hospital of Hengshui from January 2015 to February 2017 were divided into research group(n=58) and control group(n=58)according to different treatment methods.Patients in the control group were treated with arterial thrombolysis,and those in the research group were treated with SRT.The postoperative revascularization rate,the mini-mental state examination(MMSE) score before operation and on the 1st and 7th day after operation,postoperative bleeding rate,and the modified Rankin scale score(mRS) before operation and at 3,6 months after operation of the two groups were observed and analyzed.Results The postoperative revascularization rate of the research group was 84.48%,which was significantly higher than 63.79% of the control group(P<0.01).On the 1st and 7th day after operation,the MMSE scores of the two groups were higher than that on the first day before surgery,and the MMSE score of the research group was significantly higher than that of the control group(P<0.05 or P<0.01).The postoperative bleeding rate of the research group was 5.17%,which was significantly lower than 22.41% of the control group(P<0.01).At 3 and 6 months after operation,the mRS scores of the two groups were significantly lower than those before surgery,and the mRS score of the research group was significantly lower than that of the control group(P<0.05 or P<0.01).Conclusion In patients with moderate to severe ACI,the use of SRT can quickly remove thrombosis in diseased blood vessels,restore blood perfusion,and increase the revascularization rate.In addition,it has a lower incidence rate of postoperative bleeding complications and a good safety,and is of positive significance in the recovery of postoperative neurological function.
Objective To analyze the effects of stent retriever-based thrombectomy(SRT) and arterial thrombolysis on revascularization,neurological function and bleeding in patients with moderate to severe acute cerebral infarction(ACI).Methods A total of 116 patients with moderate to severe ACI admitted to Sixth Hospital of Hengshui from January 2015 to February 2017 were divided into research group(n=58) and control group(n=58)according to different treatment methods.Patients in the control group were treated with arterial thrombolysis,and those in the research group were treated with SRT.The postoperative revascularization rate,the mini-mental state examination(MMSE) score before operation and on the 1st and 7th day after operation,postoperative bleeding rate,and the modified Rankin scale score(mRS) before operation and at 3,6 months after operation of the two groups were observed and analyzed.Results The postoperative revascularization rate of the research group was 84.48%,which was significantly higher than 63.79% of the control group(P<0.01).On the 1st and 7th day after operation,the MMSE scores of the two groups were higher than that on the first day before surgery,and the MMSE score of the research group was significantly higher than that of the control group(P<0.05 or P<0.01).The postoperative bleeding rate of the research group was 5.17%,which was significantly lower than 22.41% of the control group(P<0.01).At 3 and 6 months after operation,the mRS scores of the two groups were significantly lower than those before surgery,and the mRS score of the research group was significantly lower than that of the control group(P<0.05 or P<0.01).Conclusion In patients with moderate to severe ACI,the use of SRT can quickly remove thrombosis in diseased blood vessels,restore blood perfusion,and increase the revascularization rate.In addition,it has a lower incidence rate of postoperative bleeding complications and a good safety,and is of positive significance in the recovery of postoperative neurological function.
引文
[1]熊波,李航,史树贵,等.Solitaire支架机械取栓与选择性动脉溶栓治疗急性脑梗死的疗效比较[J].局解手术学杂志,2017,26(3):185-188.
[2]李弘钧,王兴霞,许远陵,等.国产盐酸丁咯地尔注射液治疗急性脑梗死的临床研究[J].中国临床药理学与治疗学杂志,2000,5(4):357-358.
[3]张健颖,白青科,赵晓晖,等.伴有大动脉狭窄的脑梗死行支架取栓和静脉溶栓的对比研究[J].中国实验诊断学,2017,21(12):2100-2104.
[4]吴迎春,王俊梅,王哲,等.尿激酶静脉溶栓联合Solitaire AB支架取栓在前循环大动脉急性闭塞性脑梗死治疗中的应用研究[J].脑与神经疾病杂志,2017,25(8):497-502.
[5]陈新,芦云,陈晓虹.急性脑梗死患者血清HbA1c水平及其与病情、神经功能和预后的相关性研究[J].解放军医药杂志,2017,29(10):68-71.
[6]陈晓辉,钟孟飞,杨志杰,等.Solitaire支架血管内机械取栓治疗急性大脑中动脉闭塞效果分析[J].中国现代神经疾病杂志,2017,17(11):793-799.
[7]Lazzeri C,Bonizzoli M,Cozzolino M,et al.Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome[J].J Crit Care,2016,33:132-136.
[8]周华勇,龙继发,季一飞,等.动静脉联合溶栓及机械取栓治疗急性脑梗死的效果[J].中国临床研究,2018,31(2):211-214.
[9]孙军,温昌明,张保朝,等.Solitaire AB支架取栓联合尿激酶动脉溶栓治疗急性脑梗死的疗效及对神经功能的影响[J].中国地方病防治杂志,2017,32(9):1063-1065.
[10]荆传宝,任树军.介入溶栓治疗急性脑梗死128例临床分析[J].临床误诊误治,2016,29(10):36-38.
[11]高宗恩,陈晓辉,陈健,等.以机械取栓为主的动脉内多模式方法治疗急性大动脉闭塞性脑梗死的效果分析[J].中国脑血管病杂志,2017,14(2):71-76.
[12]傅懋林,戴为正,张永刚,等.Solitaire支架动脉取栓术联合多模式血管再通术治疗急性脑梗死疗效观察[J].天津医药,2017,45(10):1053-1057.
[13]吴秀民,刘和敏,杨树春,等.小剂量尿激酶联合降纤酶改善急性脑梗死缺血半暗区的临床观察[J].临床误诊误治,2006,19(1):5-7.
[14]Tsukamoto H,Suga T,Takenaka S,et al.Greater impact of acute high-intensity interval exercise on post-exercise executive function compared to moderate-intensity continuous exercise[J].Physiol Behav,2016,155:224-230.
[15]许泽武,刘珍珍,陈阵,等.重组组织型纤溶酶原激活剂治疗急性脑梗死效果荟萃分析[J].临床误诊误治,2012,25(4):42-45.
[16]荆传宝,任树军.介入溶栓治疗急性脑梗死128例临床分析[J].临床误诊误治,2016,29(B10):36-38.
[17]李桂林,杜世伟,李静伟,等.静脉溶栓桥接动脉内取栓治疗颅内大血管急性闭塞的效果分析[J].中国脑血管病杂志,2017,14(3):122-126.
[18]韩凝,张帆,郜利会,等.头颅MRI对急性颅内大动脉梗死动脉溶栓患者的筛选价值[J].河北医科大学学报,2016,37(9):1076-1079.
[19]柳青,刘毅,朱青峰,等.支架取栓治疗静脉溶栓禁忌证的急性缺血性脑卒中患者的对照研究[J].中国药物与临床,2018,28(1):26-30.
[20]申东峰,王宝山.支架取栓术与动脉溶栓术治疗急性缺血性脑卒中的疗效观察[J].中西医结合心脑血管病杂志,2017,15(10):1237-1239.
[21]徐瑞,殷世武,王转,等.支架取栓与动脉溶栓治疗急性缺血性脑卒中比较[J].介入放射学杂志,2016,25(12):1027-1030.
[2]李弘钧,王兴霞,许远陵,等.国产盐酸丁咯地尔注射液治疗急性脑梗死的临床研究[J].中国临床药理学与治疗学杂志,2000,5(4):357-358.
[3]张健颖,白青科,赵晓晖,等.伴有大动脉狭窄的脑梗死行支架取栓和静脉溶栓的对比研究[J].中国实验诊断学,2017,21(12):2100-2104.
[4]吴迎春,王俊梅,王哲,等.尿激酶静脉溶栓联合Solitaire AB支架取栓在前循环大动脉急性闭塞性脑梗死治疗中的应用研究[J].脑与神经疾病杂志,2017,25(8):497-502.
[5]陈新,芦云,陈晓虹.急性脑梗死患者血清HbA1c水平及其与病情、神经功能和预后的相关性研究[J].解放军医药杂志,2017,29(10):68-71.
[6]陈晓辉,钟孟飞,杨志杰,等.Solitaire支架血管内机械取栓治疗急性大脑中动脉闭塞效果分析[J].中国现代神经疾病杂志,2017,17(11):793-799.
[7]Lazzeri C,Bonizzoli M,Cozzolino M,et al.Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome[J].J Crit Care,2016,33:132-136.
[8]周华勇,龙继发,季一飞,等.动静脉联合溶栓及机械取栓治疗急性脑梗死的效果[J].中国临床研究,2018,31(2):211-214.
[9]孙军,温昌明,张保朝,等.Solitaire AB支架取栓联合尿激酶动脉溶栓治疗急性脑梗死的疗效及对神经功能的影响[J].中国地方病防治杂志,2017,32(9):1063-1065.
[10]荆传宝,任树军.介入溶栓治疗急性脑梗死128例临床分析[J].临床误诊误治,2016,29(10):36-38.
[11]高宗恩,陈晓辉,陈健,等.以机械取栓为主的动脉内多模式方法治疗急性大动脉闭塞性脑梗死的效果分析[J].中国脑血管病杂志,2017,14(2):71-76.
[12]傅懋林,戴为正,张永刚,等.Solitaire支架动脉取栓术联合多模式血管再通术治疗急性脑梗死疗效观察[J].天津医药,2017,45(10):1053-1057.
[13]吴秀民,刘和敏,杨树春,等.小剂量尿激酶联合降纤酶改善急性脑梗死缺血半暗区的临床观察[J].临床误诊误治,2006,19(1):5-7.
[14]Tsukamoto H,Suga T,Takenaka S,et al.Greater impact of acute high-intensity interval exercise on post-exercise executive function compared to moderate-intensity continuous exercise[J].Physiol Behav,2016,155:224-230.
[15]许泽武,刘珍珍,陈阵,等.重组组织型纤溶酶原激活剂治疗急性脑梗死效果荟萃分析[J].临床误诊误治,2012,25(4):42-45.
[16]荆传宝,任树军.介入溶栓治疗急性脑梗死128例临床分析[J].临床误诊误治,2016,29(B10):36-38.
[17]李桂林,杜世伟,李静伟,等.静脉溶栓桥接动脉内取栓治疗颅内大血管急性闭塞的效果分析[J].中国脑血管病杂志,2017,14(3):122-126.
[18]韩凝,张帆,郜利会,等.头颅MRI对急性颅内大动脉梗死动脉溶栓患者的筛选价值[J].河北医科大学学报,2016,37(9):1076-1079.
[19]柳青,刘毅,朱青峰,等.支架取栓治疗静脉溶栓禁忌证的急性缺血性脑卒中患者的对照研究[J].中国药物与临床,2018,28(1):26-30.
[20]申东峰,王宝山.支架取栓术与动脉溶栓术治疗急性缺血性脑卒中的疗效观察[J].中西医结合心脑血管病杂志,2017,15(10):1237-1239.
[21]徐瑞,殷世武,王转,等.支架取栓与动脉溶栓治疗急性缺血性脑卒中比较[J].介入放射学杂志,2016,25(12):1027-1030.