Dyna-CT在顱內(nèi)支架成形術(shù)中的應(yīng)用研究及評價
發(fā)布時間：2018-12-12 05:28
【摘要】：背景顱內(nèi)動脈狹窄(ICAD)是缺血性腦卒中的首要致病因素,關(guān)于其治療一直存在爭議,雖然2014年1月發(fā)表的支架植入術(shù)和積極藥物干預治療顱內(nèi)動脈狹窄患者卒中復發(fā)(Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis, SAMMPRIS)試驗最終結(jié)果認為：通過藥物治療優(yōu)于支架手術(shù)。然而許多研究者對該研究結(jié)果表示質(zhì)疑,近期的多個單中心報道也表明：對已經(jīng)給予雙抗后仍出現(xiàn)缺血事件的患者行支架治療是必要的。為進一步提高支架手術(shù)的療效,要求醫(yī)生更好地了解血管狹窄的細節(jié)情況、更準確地釋放支架、更及時地發(fā)現(xiàn)并發(fā)癥等,在傳統(tǒng)造影系統(tǒng)上這是難以實現(xiàn)的要求。為解決以上難題,西門子公司2005年推出了數(shù)字平板造影機的C臂旋轉(zhuǎn)并斷層重建技術(shù)一-yna-CT技術(shù)。目前該技術(shù)在國內(nèi)尚未廣泛應(yīng)用,因此有關(guān)其在顱內(nèi)動脈狹窄支架成形術(shù)中應(yīng)用的報道較少,有待研究。目的 總結(jié)顱內(nèi)動脈狹窄患者支架成形時應(yīng)用Dyna-CT的經(jīng)驗并評價其實用價值。方法 病例回顧性研究,將2007年3月至2013年6月在我院和長海醫(yī)院(本人2014年在長海醫(yī)院進修時獲洪波教授同意參閱其患者病歷資料)住院接受支架手術(shù)的顱內(nèi)動脈狹窄患者共348例分成兩組,A組179例在具備Dyna-CT功能的西門子造影機室手術(shù),B組169例在不具備Dyna-CT功能的飛利浦造影機室治療。對比兩組病例以下指標：手術(shù)成功率、支架成形術(shù)耗時、手術(shù)并發(fā)癥發(fā)生率、支架內(nèi)再狹窄發(fā)生率((In Stent Restenosis, ISR)、對血管狹窄部位斑塊的檢出率、圍手術(shù)期的改良Rankin量表(Modified Rankin Scale, mRS)評分差值。數(shù)據(jù)處理與分析使用SPSS 17.0統(tǒng)計軟件,檢驗方法為獨立樣本t檢驗、卡方檢驗、非參數(shù)檢驗,以P0.05為差異具有統(tǒng)計學意義。結(jié)果 (1)通過預設(shè)病例選擇標準本研究共納入348例患者,7例手術(shù)未成功,其中A組4例,B組3例,手術(shù)成功率分別為A組97.8%(175/179),B組98.2%(166/169),兩組手術(shù)成功率無差異(P0.05)；(2)以麻醉記錄單為耗時依據(jù),采用局麻-造影-全麻-支架置入的情況下耗時(分鐘)分別為A組62.21±21.916,B組59.31±14.807,兩組手術(shù)時間無差異(P0.05)。采用全麻-造影-支架置入術(shù),耗時分別為A組99.88±23.454,B組99.82±21.475,兩組手術(shù)時間無差異(P0.05)；(3)兩組病例共發(fā)生21例嚴重神經(jīng)系統(tǒng)相關(guān)并發(fā)癥,其中術(shù)中出血8例,死亡4例；術(shù)中血栓形成5例,死亡1例；術(shù)后24～48小時內(nèi)發(fā)生穿支血管梗死6例。并發(fā)癥發(fā)生率分別為A組4.5%(8/179),B組7.7%(13/169),兩組病例手術(shù)并發(fā)癥發(fā)生率無差異(P0.05)；(4)支架內(nèi)再狹窄發(fā)生率分別為A組15.40%(27/175),B組24.10%(40/166),兩組的支架內(nèi)再狹窄發(fā)生率有差異(P0.05)；(5)在血管狹窄部位共檢出168個斑塊,檢出率49.2%,其中A組檢出率為66.9%(117/175),B組30.7%(51/166),兩組病例的血管狹窄部位斑塊檢出率有差異(P0.05)；(6)入院和出院時的mRS評分差值分別為A組0.41±1.193,B組0.40±0.953,兩組無差異(P0.05)。結(jié)論 在顱內(nèi)動脈狹窄支架成形術(shù)中應(yīng)用Dyna-CT能更好了解狹窄部位細節(jié),降低術(shù)后支架內(nèi)再狹窄發(fā)生率,在癥狀性顱內(nèi)動脈狹窄患者的介入治療中具有實用價值。
[Abstract]:Background Intracranial Arterial Stenosis (ICAD) is the leading cause of ischemic stroke, and there has been a dispute over its treatment, although stent implantation and active drug intervention, published in January 2014, have been used to treat stroke recurrence in patients with intracranial arterial stenosis (Stenting and Aggressive Medical Management for Prev. The final result of the SAMMPRIS test was that the treatment was superior to the stent procedure by drug therapy. Many researchers, however, have questioned the results of the study, and several recent single-center reports have also shown that it is necessary to treat a patient with an ischemic event that has been treated with double-resistance. In order to further improve the curative effect of the stent, the surgeon is required to better understand the details of the vessel stenosis, to release the stent more accurately and to find the complications in a timely manner, which is difficult to achieve on the conventional contrast system. In order to solve the above problems, Siemens introduced the technology of C-arm rotation and fault reconstruction of the digital flat-plate-radiography machine in 2005. At present, the technology has not been widely used in the country, so the report about the application of the technology in the treatment of intracranial arterial stenosis is less and needs to be studied. Objective To summarize the experience of Dyna-CT in the treatment of intracranial arterial stenosis and to evaluate its value. Methods A retrospective study was conducted, and 348 cases of intracranial arterial stenosis who received stent operation from March 2007 to June 2013 in our hospital and Changhai Hospital (in 2014 at the Changhai Hospital in 2014) were divided into two groups. In group A, 179 patients were operated in a Siemens radiography room with Dyna-CT function, and 169 cases in group B were treated with a Philips radiography room without the function of Dyna-CT. The following indexes were compared between the two groups: the success rate of the operation, the time-consuming of stent-plasty, the rate of complications of the operation, the incidence of restenosis in the stent, and the modified Rankin Scale (mRS) score of the modified Rankin Scale (mRS) in the perioperative period. The data processing and analysis were SPSS 10.0. The test method was the independent sample t-test, the card-side test, the non-invasive test, and the difference was statistically significant with the difference of P0.05. Results (1) A total of 348 patients were included in the study through the pre-set case selection criteria. 7 cases were not successful. Among them, 4 of group A and 3 in group B, the success rate of operation was 97.8% (175/ 179) in group A and 98.2% in group B (166/ 169). The time-consuming (minutes) in the use of the local anesthesia-contrast-general anesthesia-stent placement was in group A, 62.21, 21.916, group B, 59.1, 147.807, and there was no difference between the two groups (P0.05). in group A, 99. 88, 23. 454, group B, 99. 82 and 21. 475, respectively, were used in group A, and there were no difference between the two groups (P0.05). (3) there were 21 serious neurological complications in both groups, including 8 cases of intraoperative hemorrhage and 4 cases of death; There were 5 cases of thrombosis in the operation, one in death, and 6 cases of vascular infarction in 24 to 48 hours after operation. The incidence of complication was 4. 5% (8/ 179) in group A and 7. 7% in group B (13/ 169). There was no difference in the incidence of complication in the two groups (P0.05). (4) The incidence of restenosis in the stent was 15.40% (27/ 175) in group A and 24.10% (40/ 166) in group B. (5) A total of 168 plaques were detected in the area of blood vessel stenosis. The detection rate was 42.2%. The detection rate of group A was 66. 9% (117/ 175) and that of group B was 30.7% (51/ 166). There was no difference between the two groups (P0.05). Conclusion The use of Dyna-CT in the treatment of intracranial arterial stenosis can better understand the details of the narrow part, reduce the incidence of restenosis after operation, and have practical value in the interventional treatment of the patients with symptomatic intracranial arterial stenosis.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R651.12
本文編號：2374005
[Abstract]:Background Intracranial Arterial Stenosis (ICAD) is the leading cause of ischemic stroke, and there has been a dispute over its treatment, although stent implantation and active drug intervention, published in January 2014, have been used to treat stroke recurrence in patients with intracranial arterial stenosis (Stenting and Aggressive Medical Management for Prev. The final result of the SAMMPRIS test was that the treatment was superior to the stent procedure by drug therapy. Many researchers, however, have questioned the results of the study, and several recent single-center reports have also shown that it is necessary to treat a patient with an ischemic event that has been treated with double-resistance. In order to further improve the curative effect of the stent, the surgeon is required to better understand the details of the vessel stenosis, to release the stent more accurately and to find the complications in a timely manner, which is difficult to achieve on the conventional contrast system. In order to solve the above problems, Siemens introduced the technology of C-arm rotation and fault reconstruction of the digital flat-plate-radiography machine in 2005. At present, the technology has not been widely used in the country, so the report about the application of the technology in the treatment of intracranial arterial stenosis is less and needs to be studied. Objective To summarize the experience of Dyna-CT in the treatment of intracranial arterial stenosis and to evaluate its value. Methods A retrospective study was conducted, and 348 cases of intracranial arterial stenosis who received stent operation from March 2007 to June 2013 in our hospital and Changhai Hospital (in 2014 at the Changhai Hospital in 2014) were divided into two groups. In group A, 179 patients were operated in a Siemens radiography room with Dyna-CT function, and 169 cases in group B were treated with a Philips radiography room without the function of Dyna-CT. The following indexes were compared between the two groups: the success rate of the operation, the time-consuming of stent-plasty, the rate of complications of the operation, the incidence of restenosis in the stent, and the modified Rankin Scale (mRS) score of the modified Rankin Scale (mRS) in the perioperative period. The data processing and analysis were SPSS 10.0. The test method was the independent sample t-test, the card-side test, the non-invasive test, and the difference was statistically significant with the difference of P0.05. Results (1) A total of 348 patients were included in the study through the pre-set case selection criteria. 7 cases were not successful. Among them, 4 of group A and 3 in group B, the success rate of operation was 97.8% (175/ 179) in group A and 98.2% in group B (166/ 169). The time-consuming (minutes) in the use of the local anesthesia-contrast-general anesthesia-stent placement was in group A, 62.21, 21.916, group B, 59.1, 147.807, and there was no difference between the two groups (P0.05). in group A, 99. 88, 23. 454, group B, 99. 82 and 21. 475, respectively, were used in group A, and there were no difference between the two groups (P0.05). (3) there were 21 serious neurological complications in both groups, including 8 cases of intraoperative hemorrhage and 4 cases of death; There were 5 cases of thrombosis in the operation, one in death, and 6 cases of vascular infarction in 24 to 48 hours after operation. The incidence of complication was 4. 5% (8/ 179) in group A and 7. 7% in group B (13/ 169). There was no difference in the incidence of complication in the two groups (P0.05). (4) The incidence of restenosis in the stent was 15.40% (27/ 175) in group A and 24.10% (40/ 166) in group B. (5) A total of 168 plaques were detected in the area of blood vessel stenosis. The detection rate was 42.2%. The detection rate of group A was 66. 9% (117/ 175) and that of group B was 30.7% (51/ 166). There was no difference between the two groups (P0.05). Conclusion The use of Dyna-CT in the treatment of intracranial arterial stenosis can better understand the details of the narrow part, reduce the incidence of restenosis after operation, and have practical value in the interventional treatment of the patients with symptomatic intracranial arterial stenosis.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R651.12
【參考文獻】
相關(guān)期刊論文 前3條
1 侯永革;劉輝;楊建芳;薛銀萍;朱榮彥;盧海麗;柳曉鋒;楊茜;劉翠平;;藥物與支架置入治療癥狀性腦動脈狹窄的療效比較[J];河北醫(yī)藥;2013年05期
2 高紅華;高連波;;支架成形術(shù)及藥物治療癥狀性大腦中動脈狹窄的隨機對照研究[J];介入放射學雜志;2013年02期
3 白玫;劉彬;;采用體模評價DynaCT成像質(zhì)量和輻射劑量[J];醫(yī)療衛(wèi)生裝備;2009年09期
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