顱內(nèi)外重度動脈狹窄患者藥物治療與血管內(nèi)支架植入治療卒中復(fù)發(fā)評估
發(fā)布時間：2018-08-08 16:00
【摘要】：目的:探討河北滄州地區(qū)顱內(nèi)外重度動脈狹窄患者藥物治療與血管內(nèi)支架植入術(shù)治療卒中復(fù)發(fā)的差異,以期尋找滄州地區(qū)顱內(nèi)外重度動脈狹窄患者的卒中最佳治療方法。方法:1研究對象選擇選取2007年6月-2013年6月800例河北省滄州市人民醫(yī)院顱內(nèi)外動脈狹窄(70-99%)的患者,符合1995年全國腦血管會議制定的腦卒中標(biāo)準(zhǔn)。分為藥物治療組和血管內(nèi)支架植入組,兩組在性別、年齡、高血壓、高脂血癥、糖尿病、吸煙史腦血管病危險因素上差異無統(tǒng)計學(xué)差異。2治療方法①藥物治療組:按照缺血性腦卒中二級預(yù)防指南,積極控制患者危險因素,給予拜阿司匹林100mg/d、硫酸氫氯吡格雷75mg/d;聯(lián)合應(yīng)用3月后,改為拜阿司匹林100mg/d;②動脈支架植入組:按照正確動脈支架植入操作方法,釋放支架,解脫支架后,支架內(nèi)殘余狹窄率小于30%,血流正向流動順暢,提示支架釋放成功。對于狹窄大于30%病人需再次進(jìn)行球囊后擴張,全麻患者清醒后再次對患者進(jìn)行神經(jīng)系統(tǒng)功能檢查;術(shù)后應(yīng)用藥物治療:給予拜阿司匹林100mg/d、硫酸氫氯吡格雷75mg/d;雙抗聯(lián)合應(yīng)用3月后,改為拜阿司匹林100mg/d長期使用。3觀察方法患者出院后第1年、第2年,進(jìn)行頭、頸CTA或DSA復(fù)檢,比較血管的狹窄情況,行頭MRI了解是否存在新的卒中發(fā)生,記錄責(zé)任血管閉塞、再狹窄情況及短暫性腦缺血發(fā)作、腦梗死的發(fā)生情況,應(yīng)用NIHSS評分進(jìn)行神經(jīng)系統(tǒng)綜合的評定。結(jié)果:對兩種治療方法卒中復(fù)發(fā)情況和神經(jīng)功能評定進(jìn)行比較,隨訪1年,藥物組新發(fā)卒中生率為23.08%,狹窄血管供血區(qū)卒中占18.9%,死亡率5.7%,而血管內(nèi)支架植入治療組新發(fā)卒中發(fā)生率為17.0%,狹窄血管供血區(qū)卒中占10.24%,死亡率3.07%,兩者比較差異有統(tǒng)計學(xué)意義(P0.05);隨訪2年,藥物組新發(fā)卒中生率為38.1%,狹窄血管供血區(qū)卒中占30.44%,死亡率8.65%,而血管內(nèi)支架植入治療組新發(fā)卒中發(fā)生率為26.6%,狹窄血管供血區(qū)卒中占14.95%,死亡率4.91%,兩者比較差異有統(tǒng)計學(xué)意義(P0.05);血管內(nèi)支架植入組在出院后1年、2年的NIHSS評分均優(yōu)于藥物治療組,兩者存在顯著差異(P0.05)。結(jié)論:針對重度顱內(nèi)外動脈狹窄患者,血管內(nèi)支架植入在患者出院后1年、2年的隨訪中,新發(fā)缺血性卒中發(fā)生率、患者死亡率,平均NIHSS評分方面經(jīng)統(tǒng)計學(xué)處理后均優(yōu)于藥物治療組。在河北滄州地區(qū),對重度顱內(nèi)外動脈狹窄患者行血管內(nèi)支架植入術(shù)治療,對預(yù)防腦血管病復(fù)發(fā)有效。
[Abstract]:Objective: to explore the difference between drug therapy and endovascular stent implantation in the treatment of stroke recurrence in patients with severe extracranial and extracranial arterial stenosis in Cangzhou, Hebei Province, in order to find the best treatment method for stroke in patients with severe intracranial and extracranial artery stenosis. Methods from June 2007 to June 2013, 800 patients with intracranial and external artery stenosis (70-99%) in Cangzhou people's Hospital of Hebei Province were selected. They were divided into two groups: drug therapy group and intravascular stent implantation group. The two groups were divided into two groups: sex, age, hypertension, hyperlipidemia, diabetes mellitus. There was no significant difference in risk factors of cerebrovascular diseases in smoking history. 2 treatment methods 1 Drug treatment group: according to the secondary prevention guidelines of ischemic stroke, the risk factors of patients were actively controlled. Give aspirin 100 mg / d, hydrogen clopidogrel sulfate 75 mg / d; after 3 months of combined use, change to aspirin 100 mg / d 2 arterial stent implantation group: according to the correct method of arterial stent implantation, release the stent, release the stent, The residual stenosis rate was less than 30%, and the flow of blood was smooth, indicating that stent release was successful. For the patients with stenosis more than 30%, the patients should be dilated again after balloon dilatation, and the patients with general anesthesia should be examined again for nervous system function after waking up. Postoperative drug therapy: aspirin 100 mg / d, hydroclopidogrel sulfate 75 mg / d, double antibody combined therapy 3 months later, patients with long-term use of Aspirin 100mg/d 3 years after discharge, second year, head, neck CTA or DSA were re-examined, and the patients were treated with Aspirin 100 mg / d and clopidogrel sulfate 75 mg / d, respectively. To compare the stenosis of blood vessels, MRI was used to evaluate the occurrence of new stroke, to record the occlusion of responsible vessels, restenosis, transient ischemic attack and cerebral infarction, and to evaluate the nervous system by NIHSS score. Results: the recurrence of stroke and the evaluation of neurological function were compared between the two methods. The patients were followed up for 1 year. The incidence of new stroke was 23.08 in the drug group, 18.9 in the narrow blood supply area, and 5.7in the intravascular stent implantation group. The incidence of new stroke was 17.0 in the stent implantation group, 10.244in the narrow blood supply area, and 3.07 in the drug group. There was a statistical difference between the two groups. Academic significance (P0.05); follow up for 2 years, The rate of new stroke in the drug group was 38.1%, the rate of stroke in the narrow blood supply area was 30.44 and the mortality was 8.65. In the treatment group, the incidence of new stroke was 26.6. the incidence of stroke in the narrow blood supply area was 14.95 and the mortality rate was 4.91. The difference between the two groups was statistically significant. The NIHSS scores in the endovascular stent implantation group were better than those in the drug treatment group in 1 year and 2 years after discharge (P0.05). There was significant difference between them (P0.05). Conclusion: for the patients with severe intracranial and external artery stenosis, the incidence of new ischemic stroke and the mortality of the patients were observed during the follow-up of 1 year and 2 years after discharge. The average NIHSS score was better than that in the drug treatment group after statistical treatment. In Cangzhou area of Hebei Province, endovascular stent implantation is effective in preventing the recurrence of cerebrovascular disease in patients with severe intracranial and external artery stenosis.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3
本文編號：2172294
[Abstract]:Objective: to explore the difference between drug therapy and endovascular stent implantation in the treatment of stroke recurrence in patients with severe extracranial and extracranial arterial stenosis in Cangzhou, Hebei Province, in order to find the best treatment method for stroke in patients with severe intracranial and extracranial artery stenosis. Methods from June 2007 to June 2013, 800 patients with intracranial and external artery stenosis (70-99%) in Cangzhou people's Hospital of Hebei Province were selected. They were divided into two groups: drug therapy group and intravascular stent implantation group. The two groups were divided into two groups: sex, age, hypertension, hyperlipidemia, diabetes mellitus. There was no significant difference in risk factors of cerebrovascular diseases in smoking history. 2 treatment methods 1 Drug treatment group: according to the secondary prevention guidelines of ischemic stroke, the risk factors of patients were actively controlled. Give aspirin 100 mg / d, hydrogen clopidogrel sulfate 75 mg / d; after 3 months of combined use, change to aspirin 100 mg / d 2 arterial stent implantation group: according to the correct method of arterial stent implantation, release the stent, release the stent, The residual stenosis rate was less than 30%, and the flow of blood was smooth, indicating that stent release was successful. For the patients with stenosis more than 30%, the patients should be dilated again after balloon dilatation, and the patients with general anesthesia should be examined again for nervous system function after waking up. Postoperative drug therapy: aspirin 100 mg / d, hydroclopidogrel sulfate 75 mg / d, double antibody combined therapy 3 months later, patients with long-term use of Aspirin 100mg/d 3 years after discharge, second year, head, neck CTA or DSA were re-examined, and the patients were treated with Aspirin 100 mg / d and clopidogrel sulfate 75 mg / d, respectively. To compare the stenosis of blood vessels, MRI was used to evaluate the occurrence of new stroke, to record the occlusion of responsible vessels, restenosis, transient ischemic attack and cerebral infarction, and to evaluate the nervous system by NIHSS score. Results: the recurrence of stroke and the evaluation of neurological function were compared between the two methods. The patients were followed up for 1 year. The incidence of new stroke was 23.08 in the drug group, 18.9 in the narrow blood supply area, and 5.7in the intravascular stent implantation group. The incidence of new stroke was 17.0 in the stent implantation group, 10.244in the narrow blood supply area, and 3.07 in the drug group. There was a statistical difference between the two groups. Academic significance (P0.05); follow up for 2 years, The rate of new stroke in the drug group was 38.1%, the rate of stroke in the narrow blood supply area was 30.44 and the mortality was 8.65. In the treatment group, the incidence of new stroke was 26.6. the incidence of stroke in the narrow blood supply area was 14.95 and the mortality rate was 4.91. The difference between the two groups was statistically significant. The NIHSS scores in the endovascular stent implantation group were better than those in the drug treatment group in 1 year and 2 years after discharge (P0.05). There was significant difference between them (P0.05). Conclusion: for the patients with severe intracranial and external artery stenosis, the incidence of new ischemic stroke and the mortality of the patients were observed during the follow-up of 1 year and 2 years after discharge. The average NIHSS score was better than that in the drug treatment group after statistical treatment. In Cangzhou area of Hebei Province, endovascular stent implantation is effective in preventing the recurrence of cerebrovascular disease in patients with severe intracranial and external artery stenosis.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3
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