本文選題：腦梗死　切入點：后循環(huán)　出處：《吉林大學》2014年碩士論文

【摘要】：目的： 本文探討動脈溶栓、輔助機械再通治療急性VBO所致后循環(huán)腦梗死的治療效果及其并發(fā)癥。 材料和方法： 回顧性分析近5年因VBO導致的后循環(huán)急性腦梗死患者85例，其中單純動脈溶栓治療57例，輔助機械再通28例。選擇同時期內(nèi)科藥物治療的VBO導致的后循環(huán)急性腦梗死患者50例作為對照組。收集患者年齡、發(fā)病到治療時間、血管再通情況、90d臨床預后等，并進行統(tǒng)計分析。介入治療組臨床結(jié)果評價在術后90ｄ進行（對照組在發(fā)病后90ｄ進行），根據(jù)改良的Rank評分（modified Rankin Scale，mRS），0～2分為預后良好、3～5分為不佳、6分為死亡；在介入治療組中將神志清醒和嗜睡患者合并為一組稱為嗜睡組，昏迷患者為另一組；血管再通情況根據(jù)“心肌梗死溶栓后血管再通”(Thrombolysis inmyocardial infarction，TIMI)血流分級，TIMI評分0～1分定義為血管未通，2～3分為血管再通。 結(jié)果： 治療后90ｄ單純?nèi)芩ńM、輔助機械再通組和對照組預后良好率分別為17.5%（10/57）、28.6%（8/28）和4%（2/50），死亡率分別為66.7%（38/57）、53.6%（15/28）和86%（43/50）。良好預后率方面單純動脈溶栓組、輔助機械再通組明顯優(yōu)于對照組（p=0.03；p＜0.01）；死亡率方面單純動脈溶栓組、輔助機械再通組亦明顯低于對照組（p=0.03；p＜0.01）。介入手術結(jié)束前DSA造影，單純動脈溶栓組血管再通率（TIMI2分以上）為43.8%，輔助機械再通組再通率為78.6%，兩組再通率差異有統(tǒng)計學意義（p＜0.01）；術后90ｄ單純?nèi)芩ㄅc輔助機械再通組預后良好率、死亡率方面差異無統(tǒng)計學意義（p=0.26；p=0.27）。血管未通組預后良好率為7.9%（3/38），預后不佳為18.4%（7/38），死亡率為73.7%（28/38）；血管再通組預后良好率為31.9%（15/47），預后不佳率為14.9%（7/47），死亡率為53.2%（25/47）；介入治療血管再通組患者預后好于未再通組，差異有統(tǒng)計學意義（p=0.01）。所有介入治療組患者，發(fā)病6h內(nèi)和6h以上兩組的良好預后(mRS0～2)患者比率分別為25.7%（9/35）、18.0%（9/50），差異無統(tǒng)計學意義（p=0.39）。嗜睡組與昏迷組的良好預后率分別為39.5%（15/38）、6.4%（3/47），差異無統(tǒng)計學意義（p＜0.01）。單純?nèi)芩úl(fā)腦出血4例，其中2例為癥狀性腦出血；輔助機械再通組無腦出血病例。 結(jié)論： 單純動脈溶栓、輔助機械再通均能明顯提高因VBO導致后循環(huán)急性腦梗死患者的良好預后率，降低死亡率；輔助機械再通可以提高VBO的血管再通率，可能改善單純動脈溶栓治療效果不佳患者的預后；VBO患者手術時意識狀態(tài)與患者遠期預后密切相關；VBO患者死亡的最主要原因是腦梗死及其臨床并發(fā)癥。
[Abstract]:Objective:The effect and complications of arterial thrombolysis and mechanical recanalization in the treatment of posterior circulatory cerebral infarction caused by acute VBO were studied.Materials and methods:85 patients with acute cerebral infarction caused by VBO in recent 5 years were analyzed retrospectively. Among them, 57 cases were treated with arterial thrombolytic therapy and 28 cases were treated with auxiliary mechanical recanalization.Fifty patients with acute cerebral infarction caused by VBO in the same period were selected as control group.The age of the patients, the time from onset to treatment, the recanalization of blood vessels and the clinical prognosis of 90 days were collected and analyzed statistically.The clinical results of the intervention group were evaluated 90 days after operation (the control group was treated 90 days after the onset of the disease). According to the modified Rank score, the modified Rankin scale scale / mRS0 / 2 was classified as good prognosis and 3 / 5 as poor and 6 as death;In the interventional treatment group, the conscious and sleepy patients were combined into one group called somnolence group, and the coma patients were the other group.According to the blood flow grading and TIMI score 0 ~ 1 of Thrombolysis inmyocardial infarction after thrombolytic thrombolytic revascularization after myocardial infarction, vascular recanalization was divided into two groups.Results:90 days after treatment, the prognosis of the thrombolytic alone group, the adjuvant mechanical recanalization group and the control group were 17.5 / 57 / 28.6 / 28) and 4 / 2 / 50 / 28, respectively. The mortality rates were 66.7 / 57 / 53.6 / 1528% and 8643 / 50 / 50, respectively, in the thrombolytic alone group, the adjuvant mechanical recanalization group and the control group.In terms of good prognosis, the adjuvant mechanical recanalization group was significantly better than the control group (P < 0.01), and the mortality of the simple arterial thrombolytic group was significantly lower than that of the control group (P < 0.01), and the mortality of the simple arterial thrombolytic group was significantly lower than that of the control group (P < 0.01).Before the end of interventional operation, DSA angiography showed that the recanalization rate and TIMI2 score of pure thrombolytic group were 43.8and 78.6, respectively. The difference between the two groups was statistically significant (p < 0.01), and the prognosis of simple thrombolytic thrombolysis group and adjuvant mechanical recanalization group was good 90 days after operation.There was no significant difference in mortality between 0.26 and 0.27.琛，

本文編號：1703261