本文關(guān)鍵詞： 急性腦梗死 介入血運(yùn)重建 臨床療效和安全性　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的觀察我院超早期急性腦梗死介入血運(yùn)重建的臨床療效及其安全性;觀察我院超早期急性腦梗死血運(yùn)重建的救治綠色通道的運(yùn)行情況;為我院進(jìn)一步提高超早期急性腦梗死介入血運(yùn)重建的臨床療效及其安全性和救治綠色通道的質(zhì)量改進(jìn)提供依據(jù)。方法回顧性分析2015年11月到2016年11月我院11例行超早期急性腦梗死介入血運(yùn)重建患者的一般臨床資料、發(fā)病到血管再通的各個(gè)環(huán)節(jié)所用時(shí)間、血管閉塞的部位、術(shù)后即刻mTICI血流分級(jí)和顱腦CT、術(shù)后影像學(xué)檢查(顱腦CT、CTA、MRI、MRA)、術(shù)前和術(shù)后各個(gè)時(shí)間點(diǎn)(術(shù)后即刻、術(shù)后24h、術(shù)后3天、術(shù)后1周、術(shù)后2周、術(shù)后3個(gè)月)NIHSS評(píng)分,對(duì)我院超早期急性腦梗死介入血運(yùn)重建救治的各個(gè)環(huán)節(jié)所用時(shí)間和腦卒中綠色通道流程的時(shí)間管理目標(biāo)以及超早期急性腦梗塞介入血運(yùn)重建的臨床療效及其安全性進(jìn)行分析。結(jié)果我院介入血運(yùn)重建患者與腦卒中綠色通道流程的時(shí)間管理目標(biāo)相比就診到完成顱腦CT檢查的時(shí)間達(dá)標(biāo)比率為22.2%,就診到靜脈溶栓開始時(shí)間均未達(dá)標(biāo),就診到動(dòng)脈置鞘時(shí)間達(dá)標(biāo)比率為36.4%,動(dòng)脈置鞘到開始動(dòng)脈取栓或溶栓時(shí)間均達(dá)標(biāo),動(dòng)脈置鞘到閉塞血管再通時(shí)間均達(dá)標(biāo);血管再通情況用mTICI血流分級(jí)評(píng)價(jià),再通成功率為72.7%;癥狀性顱內(nèi)出血率為37.5%;術(shù)前、術(shù)后即刻、術(shù)后24h、術(shù)后3天、術(shù)后1周、術(shù)后2周、術(shù)后3個(gè)月的NIHSS評(píng)分呈下降趨勢(shì),且配對(duì)t檢驗(yàn)顯示術(shù)后各組分別與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后90d神經(jīng)功能預(yù)后用mRS評(píng)分評(píng)價(jià),預(yù)后良好率為62.5%,預(yù)后較差率為12.5%,死亡率為25%;血管再通成功的患者預(yù)后良好率為62.5%,預(yù)后較差率為12.5%,死亡率為25%,再通不成功患者中無(wú)預(yù)后良好患者,預(yù)后較差率為33.3%,死亡率為66.7%;8例血管再通成功的患者中有4例術(shù)后完善CTA或MRA檢查,均無(wú)血管再閉塞。結(jié)論1.我院目前腦卒中綠色通道運(yùn)行中在動(dòng)脈置鞘到開始取栓、動(dòng)脈置鞘到閉塞血管再通時(shí)間達(dá)到腦卒中綠色通道流程的時(shí)間管理目標(biāo);2.我院臨床應(yīng)用介入血運(yùn)重建技術(shù)治療超早期急性腦梗死初步總結(jié)是安全的、有效的;3.我院臨床應(yīng)用介入血運(yùn)重建技術(shù)可以提高大動(dòng)脈閉塞的血管再通率,血管再通成功的患者臨床預(yù)后越好。
[Abstract]:Objective to observe the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction in our hospital. To observe the operation of green channel in the treatment of acute cerebral infarction in our hospital. To provide the basis for further improving the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction and the improvement of the quality of the treatment of green channels. Methods retrospective analysis was made from November 2015 to 2016. In November, 11 patients with super-early acute cerebral infarction underwent interventional revascularization. The time to recanalization, the location of occlusion, the mTICI blood flow grading and craniocerebral CTS immediately after operation, and the imaging examination after operation. NIHSS scores were obtained at all time points before and after operation (immediate, 24 hours, 3 days, 1 week, 2 weeks and 3 months after operation). The objective of time management for the treatment of each link of interventional revascularization of ultra-early acute cerebral infarction and the time management of green channel flow of stroke, and the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction in our hospital. Results compared with the time management target of green channel process of stroke, the ratio of time to complete CT examination in patients with interventional revascularization in our hospital was 22.2%. The starting time of venous thrombolytic therapy was not up to the standard. The rate of reaching the standard of arterial sheath insertion time was 36.4%, and the time from arterial sheath placement to beginning artery thrombolysis or thrombolysis was up to standard. The recanalization time of artery sheath to occlusive vessel was up to standard. The vascular recanalization was evaluated by mTICI blood flow grading. The successful rate of recanalization was 72.7%. The rate of symptomatic intracranial hemorrhage was 37.5%. Before, immediately after operation, 24 hours after operation, 3 days after operation, 1 week after operation, 2 weeks after operation, and 3 months after operation, the NIHSS score showed a downward trend. The paired t test showed that there were significant differences between the groups after operation and those before operation (P 0.05). 90 days after operation, the prognosis of nerve function was evaluated by mRS score. The good prognosis rate was 62.5%, the poor prognosis rate was 12.5%, and the mortality rate was 25.5%. The good prognosis rate was 62.5%, the poor prognosis rate was 12.5%, and the mortality rate was 25% in the patients with successful recanalization. The poor prognosis rate was 33.3% in the patients with unsuccessful recanalization. The mortality rate was 66.7; Of the 8 patients with successful revascularization, 4 had improved CTA or MRA examination after operation, and none of them were re-occluded. Conclusion 1. At present, during the operation of green channel of stroke in our hospital, the artery sheath is placed to begin to take thrombus. 2. The time of recanalization from artery sheath to occluded vessel reached the goal of time management of green channel flow in stroke. 2. It is safe and effective to apply interventional revascularization technique in the treatment of ultra-early acute cerebral infarction in our hospital. 3. The clinical application of interventional revascularization in our hospital can improve the recanalization rate of large artery occlusion, and the better the prognosis of the patients with successful revascularization.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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