【摘要】：目的:靜脈溶栓治療已經(jīng)成為在4.5小時時間窗內(nèi)發(fā)病的急性缺血性腦卒中患者的標(biāo)準(zhǔn)治療措施。然而,大部分患者因為各種禁忌癥而不適宜靜脈溶栓治療。目前已有證據(jù)證明機械取栓合并靜脈溶栓可以使合并大血管閉塞的患者獲益。本文旨在通過神經(jīng)科量表,分析單純支架取栓患者和藥物治療患者的有效性,安全性,從而探索單純支架取栓治療對于存在靜脈溶栓禁忌的急性缺血性腦卒中患者的應(yīng)用價值。方法:選取2016年1月至2017年1月在山西省人民醫(yī)院,太原市中心醫(yī)院及解放軍264醫(yī)院就診的急性缺血性腦卒中患者,納入標(biāo)準(zhǔn)包括大動脈閉塞,存在靜脈溶栓禁忌,發(fā)病時間在6小時內(nèi)等,給予支架取栓治療或藥物治療,治療前后給予神經(jīng)科量表評定,包括改良Rankin量表(mRS),美國國立衛(wèi)生研究院卒中量表(NIHSS),對治療前后相關(guān)量表評分,及治療后血管再通率,并發(fā)癥,死亡率,癥狀性顱內(nèi)出血率等進(jìn)行分析。結(jié)果:本研究共納入了43名患者,其中23名患者接受了支架取栓治療,20名患者接受了常規(guī)藥物治療。相對于常規(guī)藥物治療組,取栓組患者更年輕(58.70±13.23 vs69.2±11.54,P=0.009),女性更多(65.22%vs 30%,P=0.021)。取栓組患者閉塞部位包括頸總動脈閉塞1例,頸內(nèi)動脈閉塞6例,大腦中動脈M1段閉塞12例,大腦中動脈M2段閉塞2例。椎動脈和基底動脈閉塞各1例。治療后72小時平均NIHSS評分,取栓組為10(8.5),低于常規(guī)藥物治療組(P=0.043),也低于取栓組治療前評分(P0.0001)。取栓組中患者治療后90天mRS評分0-2級的率更高(47.83%vs 5%,P=0.002)。取栓組血管再通率(腦梗死溶栓系統(tǒng)等級評分2b/3級)明顯升高(86.96%vs 5%,P=0.001)。兩組患者在死亡率(8.7%vs15%,P=0.52)和癥狀性顱內(nèi)出血率(0%vs15%,P=0.054)上無統(tǒng)計學(xué)差異。結(jié)論:1.對大動脈閉塞且有靜脈溶栓禁忌的患者進(jìn)行支架取栓治療,可改善患者3天內(nèi)的NIHSS評分,提升患者的神經(jīng)功能恢復(fù)。2.對大動脈閉塞且有靜脈溶栓禁忌的患者進(jìn)行支架取栓治療,可改善患者90天的mRS評分,改善患者功能獨立性。3.對大動脈閉塞且有靜脈溶栓禁忌的患者進(jìn)行支架取栓治療,不能降低患者90天的死亡率和癥狀性顱內(nèi)出血率。
[Abstract]:Objective: intravenous thrombolytic therapy has become the standard treatment for acute ischemic stroke in 4.5 hours window. However, most patients are not suitable for intravenous thrombolysis because of various contraindications. There is evidence that mechanical thrombolysis combined with intravenous thrombolysis can benefit patients with macrovascular occlusion. The purpose of this study was to analyze the efficacy and safety of stenting alone and drug therapy in patients with acute ischemic stroke with venous thrombolytic taboos by neurologic scale, and to explore the application value of stenting alone in patients with acute ischemic stroke with venous thrombolytic taboos. Methods: patients with acute ischemic stroke were selected from January 2016 to January 2017 in Shanxi Provincial people's Hospital, Taiyuan City Hospital and PLA 264 Hospital. The included criteria included large artery occlusion and contraindication of venous thrombolysis. The onset time was within 6 hours. Stent thrombus removal or drug therapy was given before and after treatment. The neurology scale was evaluated before and after treatment, including the modified Rankin scale, (mRS), the stroke scale of the National Institutes of Health, (NIHSS), and the scores of the related scales before and after treatment. The rate of revascularization, complications, mortality and symptomatic intracranial hemorrhage were analyzed. Results: a total of 43 patients were enrolled in this study, of which 23 received stent thrombectomy and 20 received routine drug therapy. Compared with the routine drug group, the patients in the thrombectomy group were younger (58.70 鹵13.23 vs69.2 鹵11.54 vs69.2 鹵0.009) and more in the female group (65.22%vs 30 + P0. 021). In the thrombectomy group, common carotid artery occlusion was found in 1 case, internal carotid artery occlusion in 6 cases, middle cerebral artery M1 segment occlusion in 12 cases and middle cerebral artery M2 segment occlusion in 2 cases. Vertebral artery occlusion and basilar artery occlusion in 1 case. The average NIHSS score at 72 hours after treatment was 10 (8.5) in the thrombectomy group, lower than that in the routine drug treatment group (P0. 043) and lower than that in the thrombectomy group (P0. 0001). In the thrombectomy group, the rate of 0-2 mRS score was higher 90 days after treatment (47.83%vs 5 and P0. 002). The recanalization rate (2b/3 grade of thrombolytic system grade of cerebral infarction) in the thrombolysis group was significantly higher (86.96%vs 5 / P0. 001). There was no significant difference in mortality (8.7 vs 15) and symptomatic intracranial hemorrhage (0 vs 15) between the two groups. Conclusion 1. Stent thrombolysis for patients with arterial occlusion and contraindication of venous thrombolytic therapy can improve the NIHSS score and improve the recovery of nerve function of the patients within 3 days. Stent removal for patients with arterial occlusion and contraindication of venous thrombolysis can improve the mRS score of 90 days and improve functional independence of the patients. Stent thrombolysis for patients with arterial occlusion and contraindication of venous thrombolysis could not reduce the death rate and symptomatic intracranial hemorrhage rate in 90 days.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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