本文選題：顱內(nèi)大血管急性閉塞　切入點(diǎn)：靜脈溶栓　出處：《中國腦血管病雜志》2017年03期 　論文類型：期刊論文

【摘要】：目的探討靜脈溶栓橋接動(dòng)脈內(nèi)取栓開通顱內(nèi)大血管急性閉塞的安全性和有效性。方法回顧性分析首都醫(yī)科大學(xué)宣武醫(yī)院2016年1月至9月采用靜脈溶栓橋接動(dòng)脈內(nèi)取栓模式治療的63例顱內(nèi)大血管急性閉塞患者的臨床資料,靜脈溶栓開始時(shí)間在發(fā)病≤4.5 h,血管內(nèi)治療開始時(shí)間(股動(dòng)脈穿刺)在發(fā)病≤6 h。根據(jù)取栓方式將其分為單純支架取栓組(41例)和支架聯(lián)合抽吸取栓組(22例),兩組患者在性別構(gòu)成、平均年齡、閉塞部位及入院美國國立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分方面差異無統(tǒng)計(jì)學(xué)意義(均P0.05)。采用改良腦梗死溶栓試驗(yàn)(m TICI)評(píng)價(jià)血管開通效果,分析靜脈橋接下兩種動(dòng)脈內(nèi)治療方式的血管再通時(shí)間,取栓次數(shù),入院時(shí)、術(shù)后72 h和90 d的NIHSS評(píng)分,術(shù)中及術(shù)后并發(fā)癥發(fā)生情況。結(jié)果 (1)單純支架取栓組中,前循環(huán)閉塞37例(90.2%),后循環(huán)閉塞4例(9.8%);支架聯(lián)合抽吸取栓組中,前循環(huán)閉塞20例(90.9%),后循環(huán)閉塞2例(9.1%),組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后患者大血管均獲得良好開通(m TICI分級(jí):Ⅱb~Ⅲ級(jí))。(2)單純支架取栓組血管平均再通時(shí)間為(86±11)min,平均動(dòng)脈取栓次數(shù)為(2.8±0.9)次;術(shù)后并發(fā)癥發(fā)生率為14.6%(癥狀性出血5例,心源性死亡1例),90 d隨訪mRS(0~2分)患者占51.2%(21/41)。支架聯(lián)合抽吸取栓組血管平均再通時(shí)間為(83±11)min,平均動(dòng)脈取栓次數(shù)為(2.2±0.8)次,術(shù)后并發(fā)癥發(fā)生率為13.6%(癥狀性出血2例,心源性死亡1例),90 d隨訪mRS(0~2分)患者占59.1%(13/22)。兩組以上指標(biāo)比較,差異均有統(tǒng)計(jì)學(xué)意義(均P0.05)。結(jié)論靜脈溶栓橋接單純支架取栓和支架聯(lián)合抽吸取栓均能快速使顱內(nèi)閉塞大血管獲得再通,并且支架聯(lián)合抽吸取栓具有更好的再通率。但兩種技術(shù)在改善患者臨床預(yù)后方面尚有待進(jìn)一步研究。
[Abstract]:Objective to investigate the safety and efficacy of intravenous thrombolytic bridging arterial thrombolysis in the treatment of acute intracranial large vessel occlusion. Methods from January 2016 to September, Xuanwu Hospital, Capital University of Medical Sciences, was retrospectively analyzed. Clinical data of 63 patients with acute intracranial macrovascular occlusion treated by thrombectomy. The onset time of venous thrombolysis was less than 4.5 h, and that of intravascular therapy was less than 6 h. According to the method of thrombolysis, the thrombolysis was divided into two groups: 41 cases in the stenting group and 22 cases in the combined stent extraction group, both of which were divided into two groups: stenting alone group (n = 41) and stent combined extraction group (n = 22). Group A patients in the gender composition, There was no significant difference in mean age, occlusion site and NIHSS score (all P 0.05). Modified thrombolytic test (mTICI) was used to evaluate the effect of vascular patency. The recanalization time, the times of thrombus removal, the NIHSS score of 72 h and 90 d after admission, the complications during and after operation were analyzed. 37 cases of anterior circulatory occlusion and 4 cases of posterior circulation occlusion were treated with anterior circulation occlusion (37 cases) and posterior circulation occlusion group (4 cases). 20 cases with anterior circulation occlusion and 2 cases with posterior circulation occlusion had no significant difference between the two groups (P 0.05). After treatment, the major vessels of all the patients were well opened m TICI grade: 鈪，

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