ASPECT及NIHSS对早期血管内介入治疗急性缺血性脑卒中的效果评价
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摘要
目的探讨ASPECT(Alberta卒中项目早期CT评分)及NIHSS评分(美国国立卫生研究院卒中量表)对早期血管内介入治疗急性缺血性脑卒中疗效的评估价值。方法选取周口市中心医院2016-02—2017-04收治的接受早期血管内介入治疗急性缺血性脑卒中的患者100例,按照随机分配的方法分为研究组和对照组,研究组通过ASPECT及NIHSS评分评价患者的疾病发生情况并接受针对性的治疗,对照组接受传统的CT检查并作出判断。对比2组评估准确率、不同时间疾病复发情况,以及患者的满意度。结果研究组评估准确率明显高于对照组(P<0.05),研究组疾病复发率明显低于对照组(P<0.05),研究组患者的满意度明显高于对照组(P<0.05)。结论 ASPECT及NIHSS评分对接受期血管内介入治疗的急性缺血性脑卒中患者进行疾病的评估和预后的判断能够明显优化治疗效果,提高治疗的满意度,降低复发率,患者的预后较好,可行性程度较高。
Objective To explore the value of ASPECT(early CT score of Alberta stroke project) and NIHSS score(stroke scale of the national institutes of health) in evaluating the clinical efficacy of early intravascular intervention in the treatment of acute ischemic stroke.Methods A total of 100 patients with acute ischemic stroke who underwent early endovascular intervention were enrolled in Zhoukou Central Hospital from Feb. 2016 to Apr. 2017.They were divided into study group and control group according to randomized method.The study group used ASPECT and NIHSS score to evaluate the patient's disease and received targeted treatment.The control group received a conventional CT examination and made a judgment.The accuracy of the two groups,the recurrence of disease at different times,and the satisfaction of the patients were compared.Results The accuracy of the study group was significantly higher than that of the control group(P<0.05).The recurrence rate of the study group was significantly lower than that of the control group(P<0.05).The satisfaction of the study group was significantly higher than that of the control group(P<0.05).Conclusion ASPECT and NIHSS scores can significantly optimize the therapeutic effect of the disease,improve the satisfaction of the treatment,reduce the recurrence rate of the patients,and improve the prognosis and feasibility of the patients.
Objective To explore the value of ASPECT(early CT score of Alberta stroke project) and NIHSS score(stroke scale of the national institutes of health) in evaluating the clinical efficacy of early intravascular intervention in the treatment of acute ischemic stroke.Methods A total of 100 patients with acute ischemic stroke who underwent early endovascular intervention were enrolled in Zhoukou Central Hospital from Feb. 2016 to Apr. 2017.They were divided into study group and control group according to randomized method.The study group used ASPECT and NIHSS score to evaluate the patient's disease and received targeted treatment.The control group received a conventional CT examination and made a judgment.The accuracy of the two groups,the recurrence of disease at different times,and the satisfaction of the patients were compared.Results The accuracy of the study group was significantly higher than that of the control group(P<0.05).The recurrence rate of the study group was significantly lower than that of the control group(P<0.05).The satisfaction of the study group was significantly higher than that of the control group(P<0.05).Conclusion ASPECT and NIHSS scores can significantly optimize the therapeutic effect of the disease,improve the satisfaction of the treatment,reduce the recurrence rate of the patients,and improve the prognosis and feasibility of the patients.
引文
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[23] JOVIN TG,CHAMORRO A,COBO E,et al.Thrombectomywithin 8 hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372:2 296-2 306.
[24] DESAI S M,ROCHA M,MOLYNEAUX B J,et al.Thrombectomy 6-24 hours after stroke in trial ineligible patients[J].J Neurointerv Surg,2018,10(11):1 033-1 037.
[25] POWERS W J,RABINSTEIN A A,ACKERSON T,et al.2018Guidelines for the early management of patients withacute ischemic stroke:a Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2018,49:e46-e110.
[26] GOYAL M,MENON B K,VAN ZWAM W H,et al.Endovascular thrombectomy after large-vessel ischaemicstroke:a meta-analysis of individual patient data fromfive randomised trials[J].Lancet,2016,387:1 723-1 731.
[27] SAVER J L,GOYAL M,VAN DER LUGT A,et al.Time to treatment with endovascular thrombectomy and outcomesfrom ischemic stroke:A meta-analysis[J].JAMA,2016,316:1 279-1 288.
[28] NOGUEIRA R G,JADHAV A P,HAUSSEN D C,et al.Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J].N Engl J Med,2018,378:11-21.
[29] HIGASHIDA R T,FURLAN A J,ROBERTS H,et al.Trial designand reporting standards for intra-arterial cerebralthrombolysis for acute ischemic stroke[J].Stroke,2003,34:e109-e137.
[30] RYU C W,SHIN H S,PARK S,et al.Alberta stroke program early CT score in the prognostication after endovascular treatment for ischemic stroke:a meta-analysis[J].Neurointervention,2017,12(1):20-30.
[31] ALBERS G W,MARKS M P,KEMP S,et al.Thrombectomyfor stroke at 6 to 16 hours with selection by perfusionimaging[J].N Engl J Med,2018,378:708-718.
[32] PEXMAN J H,BARBER P A,HILL M D,et al.Use of theAlberta Stroke Program Early CT Score (ASPECTS)for assessing CT scans in patients with acute stroke[J].AJNR Am J Neuroradiol,2001,22:1 534-1 542.
[33] KROGIAS C,BARTIG D,KITZROW M,et al.Availability ofmechanical thrombectomy for acute stroke:analysis ofthe health care reality in Germany[J].Nervenarzt,2017,88:1 177-1 185.
[34] MUELLER-KRONAST N H,ZAIDAT O O,FROEHLER M T,et al.Systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke primaryresults of the STRATIS Registry[J].Stroke,2017,48:2 760-2 768.
[35] NASREDDINE Z S,PHILLIPS N A,BE′DIRIAN V,et al.TheMontreal Cognitive Assessment,MoCA:a brief screeningtool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53:695-699.
[36] ZAIDAT O O,CASTONGUAY A C,NOGUEIRA R G,et al.TREVO stent-retriever mechanical thrombectomy foracute ischemic stroke secondary to large vessel occlusionregistry[J].J Neurointerv Surg,2018,10(6):516-524.
[37] KASCHKA I N,KLOSKA S P,STRUFFERT T,et al.Clinical and radiological outcome after mechanical thrombectomy in acute ischemic stroke:What matters?[J].Neuroradiol J,2016,29(2):99-105.
[38] ERYILDIZ E S,?ZDEMIR A ?.Factors Associated with Early Recovery after Intravenous Thrombolytic Therapy in Acute Ischemic Stroke[J].Arch Neuropsychiatry,2018,55(1):80.
[2] HILL M D,DEMCHUK A M,GOYAL M,et al.Alberta Stroke Program early computed tomography score to select patients for endovascular treatment:Interventional Management of Stroke (IMS)-Ⅲ Trial[J].Stroke,2014,45:444-449.
[3] WEI W.Analysis on Endovascular Stent Intervention Value in Treatment of Ischemic Stroke[J].Chin Health Standard Management,2016,9(3):89-90.
[4] YAGHI S,BIANCHI N,AMOLE A,et al.ASPECTS is a predictor of favorable CT perfusion in acute ischemic stroke[J].J Neuroradiol,2014,41(3):184-187.
[5] RAZA S A,RANGARAJU S.A Review ofPre-Intervention Prognostic Scores for Early Prognostication and Patient Selection in Endovascular Management of Large Vessel Occlusion Stroke.[J].Interv Neurol,2018,7(3/4):171-181.
[6] MANTILLA-GARCIA D,MOURAND I,GASCOU G,et al.Diffusion weighted imaging and time in acute ischemic stroke,is there any relation?[J].J Neuroradiol,2017,44(6):353-360.
[7] ZHANG Q S,CHEN Q X,ZHOU Y,et al.Comparative Study of Surgical Clipping and Endovascular Interventional Therapy for Intracranial Aneurysm[J].Chin J Med Guide,2016,11(7):453-454.
[8] ROSS J R,FRANGA D L,GALLICHIO M,et al.Role of intravascular ultrasound imaging during endovascular interventions of failing hemodialysis access grafts[J].J Vasc Surg,2017,65(5):1 383-1 384.
[9] IMAHORI T,TANAKA K,ARAI A,et al.Mechanical thrombectomy for acute ischemic stroke patients aged 80 years or older[J].J Stroke Cerebrovasc Dis,2017,26(12):2 793-2 799.
[10] BEHROUZ R,MASJUáN-VALLEJO J,VERA R,et al.Outcomes of nonagenarians with acute ischemic stroke treated with intravenous thrombolytics[J].J Stroke Cerebrovasc Dis,2018,27(1):246-256.
[11] MOURAND I,MALISSART P,DARGAZANLI C,et al.A Regional Network Organization for Thrombec-tomy for Acute Ischemic Stroke in the Anterior Circulation;Timing,Safety,and Effectiveness[J].J Stroke Cerebrovasc Dis,2019,28(2):259-266.
[12] HUNGERFORD J P,HYER M,TURK A S,et al.Impact of ASPECT scores and infarct distribution on outcomes among patients undergoing thrombectomy for acute ischemic stroke with the ADAPT technique[J].J Neurointerv Surg,2017,9(9):823-829.
[13] KADA A,NISHIMURA K,NAKAGAWARA J,et al.Development and validation of a score for evaluating comprehensive stroke care capabilities:J-ASPECT Study[J].BMC Neurol,2017,17(1):46.
[14] OKUBO P,FáBIO S R C,DOMENIS D R,et al.Using the National Institute of Health Stroke Scale to predict dysphagia in acute ischemic stroke[J].Cerebrovasc Dis,2012,33(6):501-507.
[15] LIANG J,GAO P,LIN Y,et al.Susceptibility-weighted imaging in post-treatment evaluation in the early stage in patients with acute ischemic stroke[J].J Int Med Res,2019,47(1):196-205.
[16] ALEGIANI A C,DORN F,HERZBERG M,et al.Systematic evaluation of stroke thrombectomy in clinical practice:The German Stroke Registry Endovascular Treatment[J].Int J Stroke,2018:1747493018806199.
[17] GOYAL M,DEMCHUK A M,MENON B K,et al.Randomizedassessment of rapid endovascular treatment of ischemicstroke[J].N Engl J Med,2015,372:1 019-1 030.
[18] SAVER JL,GOYAL M,BONAFE A,et al.Stent-retrieverthrombectomy after intravenous t-PA vs.t-PA alone instroke[J].N Engl J Med,2015,372:2 285-2 295.
[19] CAMPBELL B C V,MITCHELL P J,KLEINIG T J,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372:1 009-1 018.
[20] BERKHEMER O A,FRANSEN P S S,BEUMER D,et al.A randomized trial of intraarterial treatment for acute ischemicstroke[J].N Engl J Med,2015,372:11-20.
[21] TSIVGOULIS G,KATSANOS A H,SCHELLINGER P D,et al.Successful reperfusion with intravenous thrombolysispreceding mechanical thrombectomy in large-vesselocclusions[J].Stroke,2018,49:232-235.
[22] ZIVELONGHI C,TAMBURIN S.Mechanical thrombectomy for acute ischemic stroke:the therapeutic window is larger but still “time is brain”[J].Fun Neurol,2018,33(1):5.
[23] JOVIN TG,CHAMORRO A,COBO E,et al.Thrombectomywithin 8 hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372:2 296-2 306.
[24] DESAI S M,ROCHA M,MOLYNEAUX B J,et al.Thrombectomy 6-24 hours after stroke in trial ineligible patients[J].J Neurointerv Surg,2018,10(11):1 033-1 037.
[25] POWERS W J,RABINSTEIN A A,ACKERSON T,et al.2018Guidelines for the early management of patients withacute ischemic stroke:a Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2018,49:e46-e110.
[26] GOYAL M,MENON B K,VAN ZWAM W H,et al.Endovascular thrombectomy after large-vessel ischaemicstroke:a meta-analysis of individual patient data fromfive randomised trials[J].Lancet,2016,387:1 723-1 731.
[27] SAVER J L,GOYAL M,VAN DER LUGT A,et al.Time to treatment with endovascular thrombectomy and outcomesfrom ischemic stroke:A meta-analysis[J].JAMA,2016,316:1 279-1 288.
[28] NOGUEIRA R G,JADHAV A P,HAUSSEN D C,et al.Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J].N Engl J Med,2018,378:11-21.
[29] HIGASHIDA R T,FURLAN A J,ROBERTS H,et al.Trial designand reporting standards for intra-arterial cerebralthrombolysis for acute ischemic stroke[J].Stroke,2003,34:e109-e137.
[30] RYU C W,SHIN H S,PARK S,et al.Alberta stroke program early CT score in the prognostication after endovascular treatment for ischemic stroke:a meta-analysis[J].Neurointervention,2017,12(1):20-30.
[31] ALBERS G W,MARKS M P,KEMP S,et al.Thrombectomyfor stroke at 6 to 16 hours with selection by perfusionimaging[J].N Engl J Med,2018,378:708-718.
[32] PEXMAN J H,BARBER P A,HILL M D,et al.Use of theAlberta Stroke Program Early CT Score (ASPECTS)for assessing CT scans in patients with acute stroke[J].AJNR Am J Neuroradiol,2001,22:1 534-1 542.
[33] KROGIAS C,BARTIG D,KITZROW M,et al.Availability ofmechanical thrombectomy for acute stroke:analysis ofthe health care reality in Germany[J].Nervenarzt,2017,88:1 177-1 185.
[34] MUELLER-KRONAST N H,ZAIDAT O O,FROEHLER M T,et al.Systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke primaryresults of the STRATIS Registry[J].Stroke,2017,48:2 760-2 768.
[35] NASREDDINE Z S,PHILLIPS N A,BE′DIRIAN V,et al.TheMontreal Cognitive Assessment,MoCA:a brief screeningtool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53:695-699.
[36] ZAIDAT O O,CASTONGUAY A C,NOGUEIRA R G,et al.TREVO stent-retriever mechanical thrombectomy foracute ischemic stroke secondary to large vessel occlusionregistry[J].J Neurointerv Surg,2018,10(6):516-524.
[37] KASCHKA I N,KLOSKA S P,STRUFFERT T,et al.Clinical and radiological outcome after mechanical thrombectomy in acute ischemic stroke:What matters?[J].Neuroradiol J,2016,29(2):99-105.
[38] ERYILDIZ E S,?ZDEMIR A ?.Factors Associated with Early Recovery after Intravenous Thrombolytic Therapy in Acute Ischemic Stroke[J].Arch Neuropsychiatry,2018,55(1):80.