椎動(dòng)脈支架成形術(shù)與后循環(huán)缺血的臨床研究
發(fā)布時(shí)間：2019-07-05 14:09
【摘要】：目的:初步探討椎動(dòng)脈支架成形術(shù)治療椎動(dòng)脈粥樣硬化狹窄的近期、遠(yuǎn)期療效及對(duì)缺血性腦血管病的防治意義。方法:按照入組標(biāo)準(zhǔn)收集于2013年1月至2016年12月期間在廣西中醫(yī)藥大學(xué)附屬瑞康醫(yī)院住院,有癥狀的椎動(dòng)脈動(dòng)脈粥樣硬化中度狹窄及以上(≥50%)的患者69例,將患者分成藥物組和支架組,支架組納入32例,藥物組納入37例,年齡在52-75歲之間。所有患者均應(yīng)用CE-MRA或CTA或DSA檢查,參照北美癥狀性頸動(dòng)脈內(nèi)膜切除術(shù)試驗(yàn)協(xié)作組(NASCET)的測(cè)量方法對(duì)血管狹窄程度進(jìn)行測(cè)量評(píng)估。藥物組的治療參考《中國(guó)缺血性腦卒中和短暫性腦缺血發(fā)作二級(jí)預(yù)防指南》進(jìn)行,以抗血小板聚集和調(diào)脂穩(wěn)定斑塊治療作為基礎(chǔ)治療,同時(shí)控制腦血管病其他的可控高危因素。支架組的治療為在藥物治療的基礎(chǔ)上進(jìn)行支架手術(shù)治療。對(duì)所有納入研究的患者進(jìn)行隨訪,觀察并記錄兩組患者的一般資料、臨床癥狀(頭暈、肢體癱瘓、平衡障礙等)的緩解情況,應(yīng)用CE-MRA或CTA或DSA對(duì)患者的血管狹窄變化情況進(jìn)行隨訪觀察,并記錄支架組患者植入支架前、中、后的病情變化,圍手術(shù)期并發(fā)癥及其處理情況。最終,支架組有2例患者,藥物組有1例患者因未能按規(guī)定的方案進(jìn)行治療,而從研究中剔除。支架組30例,藥物組36例患者,完成隨訪,平均隨訪期為19.3±5.6個(gè)月。結(jié)果:兩組患者之間的年齡、性別、高血壓、糖尿病、高脂血癥、冠狀動(dòng)脈粥樣硬化性心臟病、吸煙史、入組時(shí)椎動(dòng)脈狹窄程度等基線資料之間的差異不具有統(tǒng)計(jì)學(xué)意義(P0.05),兩組之間具有可比性。支架組30例患者成功植入椎動(dòng)脈球囊擴(kuò)張式支架31枚,支架植入手術(shù)成功率96.77%,支架植入前后前相比,血管狹窄程度從術(shù)前76.37±10.06%下降到7.63±4.41%,血管狹窄程度有明顯的改善,術(shù)后即刻造影遠(yuǎn)端分支血管顯影較前增多,支架植入術(shù)前與術(shù)后即刻血管狹窄程度對(duì)比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。支架組30天內(nèi)發(fā)生與手術(shù)相關(guān)的并發(fā)癥2例(6.45%),1例穿刺后出現(xiàn)后腹膜血腫、出血性休克,1例術(shù)中出現(xiàn)腦血管痙攣。隨訪30天、6個(gè)月時(shí)兩組患者的臨床癥狀(頭暈、肢體癱瘓、平衡障礙等)緩解率對(duì)比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);隨訪12個(gè)月時(shí)兩組TIA發(fā)生率對(duì)比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者術(shù)后、12個(gè)月、24個(gè)月時(shí)血管狹窄情況對(duì)比,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪12個(gè)月、24個(gè)月時(shí)兩組臨床癥狀緩解率對(duì)比,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪30天、6個(gè)月、24個(gè)月時(shí)兩組的TIA發(fā)生率對(duì)比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組在30天、6個(gè)月、12個(gè)月、24個(gè)月時(shí)腦梗死的發(fā)生率對(duì)比,支架組腦梗死的發(fā)生率稍少,但差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:椎動(dòng)脈支架成形術(shù)治療癥狀性椎動(dòng)脈起始部粥樣硬化狹窄可改善患者中短期的臨床癥狀。椎動(dòng)脈支架成形術(shù)治療椎動(dòng)脈起始部粥樣硬化狹窄,術(shù)后1年內(nèi)有可能減少TIA的發(fā)生率。椎動(dòng)脈支架成形術(shù)治療椎動(dòng)脈起始部粥樣硬化狹窄與藥物治療對(duì)比,術(shù)后2年內(nèi)在腦梗塞的預(yù)防上未顯示出差異。椎動(dòng)脈支架植入術(shù)對(duì)缺血性腦血管病的遠(yuǎn)期預(yù)防作用,尚需進(jìn)一步研究。
[Abstract]:Objective: To study the short-term, long-term and long-term effect of vertebral artery stent-plasty in the treatment of atherosclerosis stenosis and the significance of the prevention and treatment of ischemic cerebrovascular disease. Methods:69 patients with moderate and moderate (50%) vertebral artery atherosclerosis with symptomatic vertebral artery atherosclerosis were collected from January 2013 to December 2016 according to the criteria for enrollment, and the patients were divided into drug group and support group. The group of stent was included in 32 cases, and the drug group was included in 37 cases, and the age was between 52 and 75 years. All patients were examined with CE-MRA or CTA or DSA, and the degree of vessel stenosis was evaluated with reference to the method of measurement of the North American symptomatic carotid endarterectomy (NSCET). The treatment of the drug group is referred to as the second-level prevention guide for ischemic stroke and transient ischemic attack in China, which is based on the treatment of anti-platelet aggregation and lipid-regulating and stable plaque treatment, and the other controllable high-risk factors of the cerebrovascular disease are also controlled. The treatment of the stent group was performed on the basis of drug therapy. All patients who were included in the study were followed up to observe and record the general information of the two groups of patients, clinical symptoms (dizziness, limb paralysis, balance disorder, etc.), and follow-up observation on the change of blood vessel stenosis by CE-MRA or CTA or DSA. The patients with the support group were recorded before, during and after the implantation of the stent, and the complications of the perioperative period and their treatment were recorded. In the end, there were 2 patients in the stent group and one patient in the drug group was excluded from the study due to the failure to perform the treatment according to the prescribed protocol. The follow-up was completed in 30 patients and 36 patients, followed by a mean follow-up period of 19.3 to 5.6 months. Results: The difference of age, sex, hypertension, diabetes, hyperlipidemia, coronary atherosclerotic heart disease and smoking history among the two groups was not statistically significant (P0.05). The success rate of stent implantation was 96.77%, and the degree of vascular stenosis was decreased from 76.37% to 10.06% to 7.63% 4.41%, and the degree of vessel stenosis was significantly improved, compared with that before and after stent implantation. There was a significant difference in the degree of vascular development in the distal branch after operation (P0.05). There were 2 cases (6.45%) of complications related to the operation within 30 days of the stent group,1 case of retroperitoneal hematoma, hemorrhagic shock and 1 case of cerebral vasospasm. The response rate of the two groups was statistically significant (P <0.05) at the follow-up of 30 and 6 months (P <0.05). The incidence of TIA in the two groups was statistically significant at the follow-up of 12 months (P0.05). The changes of blood vessel stenosis at 12 months and 24 months after operation of the two groups were statistically significant (P0.05). 12-month follow-up and 24-month follow-up, there was no significant difference between the two groups of clinical remission rates (P0.05). There was no significant difference in the incidence of TIA between the two groups at 30 days,6 months and 24 months (P0.05). The incidence of cerebral infarction in the two groups at 30 days,6 months,12 months and 24 months was less, but the incidence of cerebral infarction in the group was less, but the difference was not statistically significant (P0.05). Conclusion: Vertebral artery stent-plasty can improve the short-term clinical symptoms of the patients. Vertebral artery stent-plasty was used to treat the atherosclerotic stenosis of the vertebral artery, and it was possible to reduce the incidence of TIA within one year after the operation. Vertebral artery stenting was used to treat the stenosis of the initial part of the vertebral artery and the treatment of the drug, and no difference was shown on the prevention of cerebral infarction within 2 years after the operation. The long-term preventive effect of vertebral artery stent implantation on ischemic cerebrovascular disease requires further study.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
[Abstract]:Objective: To study the short-term, long-term and long-term effect of vertebral artery stent-plasty in the treatment of atherosclerosis stenosis and the significance of the prevention and treatment of ischemic cerebrovascular disease. Methods:69 patients with moderate and moderate (50%) vertebral artery atherosclerosis with symptomatic vertebral artery atherosclerosis were collected from January 2013 to December 2016 according to the criteria for enrollment, and the patients were divided into drug group and support group. The group of stent was included in 32 cases, and the drug group was included in 37 cases, and the age was between 52 and 75 years. All patients were examined with CE-MRA or CTA or DSA, and the degree of vessel stenosis was evaluated with reference to the method of measurement of the North American symptomatic carotid endarterectomy (NSCET). The treatment of the drug group is referred to as the second-level prevention guide for ischemic stroke and transient ischemic attack in China, which is based on the treatment of anti-platelet aggregation and lipid-regulating and stable plaque treatment, and the other controllable high-risk factors of the cerebrovascular disease are also controlled. The treatment of the stent group was performed on the basis of drug therapy. All patients who were included in the study were followed up to observe and record the general information of the two groups of patients, clinical symptoms (dizziness, limb paralysis, balance disorder, etc.), and follow-up observation on the change of blood vessel stenosis by CE-MRA or CTA or DSA. The patients with the support group were recorded before, during and after the implantation of the stent, and the complications of the perioperative period and their treatment were recorded. In the end, there were 2 patients in the stent group and one patient in the drug group was excluded from the study due to the failure to perform the treatment according to the prescribed protocol. The follow-up was completed in 30 patients and 36 patients, followed by a mean follow-up period of 19.3 to 5.6 months. Results: The difference of age, sex, hypertension, diabetes, hyperlipidemia, coronary atherosclerotic heart disease and smoking history among the two groups was not statistically significant (P0.05). The success rate of stent implantation was 96.77%, and the degree of vascular stenosis was decreased from 76.37% to 10.06% to 7.63% 4.41%, and the degree of vessel stenosis was significantly improved, compared with that before and after stent implantation. There was a significant difference in the degree of vascular development in the distal branch after operation (P0.05). There were 2 cases (6.45%) of complications related to the operation within 30 days of the stent group,1 case of retroperitoneal hematoma, hemorrhagic shock and 1 case of cerebral vasospasm. The response rate of the two groups was statistically significant (P <0.05) at the follow-up of 30 and 6 months (P <0.05). The incidence of TIA in the two groups was statistically significant at the follow-up of 12 months (P0.05). The changes of blood vessel stenosis at 12 months and 24 months after operation of the two groups were statistically significant (P0.05). 12-month follow-up and 24-month follow-up, there was no significant difference between the two groups of clinical remission rates (P0.05). There was no significant difference in the incidence of TIA between the two groups at 30 days,6 months and 24 months (P0.05). The incidence of cerebral infarction in the two groups at 30 days,6 months,12 months and 24 months was less, but the incidence of cerebral infarction in the group was less, but the difference was not statistically significant (P0.05). Conclusion: Vertebral artery stent-plasty can improve the short-term clinical symptoms of the patients. Vertebral artery stent-plasty was used to treat the atherosclerotic stenosis of the vertebral artery, and it was possible to reduce the incidence of TIA within one year after the operation. Vertebral artery stenting was used to treat the stenosis of the initial part of the vertebral artery and the treatment of the drug, and no difference was shown on the prevention of cerebral infarction within 2 years after the operation. The long-term preventive effect of vertebral artery stent implantation on ischemic cerebrovascular disease requires further study.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 王擁軍;;卒中:回眸2016[J];中國(guó)卒中雜志;2017年01期
2 霍穎超;嚴(yán)家川;周華東;;顱外頸動(dòng)脈和椎動(dòng)脈狹窄支架置入術(shù)圍術(shù)期并發(fā)癥及危險(xiǎn)因素分析[J];中華老年心腦血管病雜志;2016年11期
3 張廣玉;;椎動(dòng)脈起始部粥樣硬化性狹窄患者血管內(nèi)支架置入術(shù)后再狹窄的危險(xiǎn)因素研究[J];實(shí)用心腦肺血管病雜志;2016年09期
4 姜春力;;我國(guó)人口老齡化現(xiàn)狀分析與“十三五”時(shí)期應(yīng)對(duì)戰(zhàn)略與措施[J];全球化;2016年08期
5 袁景林;;椎動(dòng)脈開口狹窄介入治療后血流動(dòng)力學(xué)狀態(tài)的變化及對(duì)腦卒中患病率的影響[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2016年14期
6 倪貴華;趙衛(wèi)東;田向陽(yáng);倪小宇;孫波;陳林芳;;癥狀性椎動(dòng)脈開口處狹窄支架成形術(shù)后再狹窄的影響因素分析[J];臨床神經(jīng)病學(xué)雜志;2016年02期
7 劉新峰;朱武生;孫文;徐格林;;中國(guó)缺血性腦血管病血管內(nèi)介入診療指南2015[J];中華神經(jīng)科雜志;2015年10期
8 謝湘桂;劉赫;賈建文;鐘紅亮;李熒;孫永全;;老年腦缺血患者顱內(nèi)外動(dòng)脈支架成形術(shù)后再狹窄分布研究[J];中華老年醫(yī)學(xué)雜志;2015年07期
9 李晶晶;蔡藝靈;劉麗;杜娟;吳錚;孔祥鍇;;椎動(dòng)脈起始部狹窄支架置入與藥物治療的對(duì)比研究[J];中國(guó)腦血管病雜志;2015年01期
10 張英謙;呂強(qiáng);張衛(wèi)清;趙炫柱;趙發(fā)國(guó);王Y，
本文編號(hào)：2510579
本文鏈接：http://sikaile.net/yixuelunwen/shenjingyixue/2510579.html
最近更新
教材專著
