發(fā)布時(shí)間：2018-10-05 09:26

【摘要】：目的 探討對(duì)急性大動(dòng)脈閉塞性腦梗死患者接受以機(jī)械取栓為主的動(dòng)脈內(nèi)多模式方法治療的有效性和安全性及其影響預(yù)后的相關(guān)因素。方法 回顧性分析56例急性大動(dòng)脈閉塞性腦梗死患者的臨床資料,觀察臨床特點(diǎn)(性別、年齡、相關(guān)基礎(chǔ)疾病)、治療時(shí)機(jī)(發(fā)病至穿刺時(shí)間、穿刺至開通時(shí)間)、多模式治療(動(dòng)脈內(nèi)溶栓、取栓、球囊擴(kuò)張、支架置入等)、責(zé)任血管分布等項(xiàng)目。評(píng)估血管再通情況采用改良腦梗死溶栓試驗(yàn)(m TICI)分級(jí),觀察術(shù)前和術(shù)后24 h神經(jīng)功能采用美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分,采用改良Rankin量表(mRS)評(píng)價(jià)術(shù)后3個(gè)月預(yù)后。根據(jù)術(shù)后3個(gè)月預(yù)后情況將入組患者分為預(yù)后良好組(34例,mRS≤2分)和預(yù)后不良組(22例,mRS≥3分),行單因素分析,再進(jìn)一步行多因素Logistic回歸分析影響預(yù)后的因素。結(jié)果 (1)56例患者血管再通率為78.6%(44例),其中基底動(dòng)脈最高,達(dá)93.8%(15/16),大腦中動(dòng)脈87.0%(20/23)。治療后24 h NIHSS評(píng)分(10±7)分,低于入院時(shí)的(16±6)分,差異有統(tǒng)計(jì)學(xué)意義(t=6.401,P0.01)。3個(gè)月預(yù)后良好34例(60.7%),死亡4例(7.1%),癥狀性顱內(nèi)出血8例(14.3%)。(2)多因素分析顯示:血管再通級(jí)別高,是良好預(yù)后的保護(hù)因素(OR=0.465,95%CI:0.267~0.809,P=0.007);糖尿病是預(yù)后不良的獨(dú)立危險(xiǎn)因素(OR=5.535,95%CI:1.101~27.835,P=0.038)。結(jié)論 急性大動(dòng)脈閉塞性腦梗死動(dòng)脈內(nèi)多模式治療能快速有效地恢復(fù)顱內(nèi)血流,具有開通率高和預(yù)后好的特點(diǎn)。并且血管再通級(jí)別越高,預(yù)后越好。而糖尿病是預(yù)后不良的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to investigate the efficacy, safety and prognostic factors of mechanical embolization in patients with acute arterial occlusive cerebral infarction. Methods the clinical data of 56 patients with acute arterial-occlusive cerebral infarction were retrospectively analyzed. The clinical features (sex, age, related basic diseases) and the time of treatment (from onset to puncture) were observed. Puncture to the opening time), multi-mode therapy (intraarterial thrombolysis, balloon dilation, stent implantation, etc.), responsible vascular distribution and so on. The recanalization of blood vessels was evaluated by modified thrombolytic test (m TICI). The neurological function was evaluated by the (NIHSS) scale of the National Institutes of Health before and 24 hours after operation, and the prognosis was evaluated by the modified Rankin scale (mRS) at 3 months after operation. According to the prognosis of 3 months after operation, the patients were divided into good prognosis group (34 cases with MRs 鈮，

本文編號(hào)：2252859