介入治疗与内科治疗在缺血性脑血管病中的应用效果比较

Application effect comparison between interventional therapy and medical treatment in treating ischemic cerebrovascular diseases

目的比较介入治疗与单纯内科治疗对缺血性脑血管病的近期治疗效果。方法回顾性研究2010年3月-2014年10月住入我院神经内科与介入科的148例经脑血管造影（DSA）诊断、CT或MRI及临床证实为缺血性脑血管患者的临床及影像学资料,其中92例行支架成形术,设为治疗组;另外56例采用常规单纯内科治疗,设为对照组。所有病例均随访12个月。分析对比介入治疗与内科治疗效果及不良反应发生情况。结果治疗组92例全部成功置入支架,所有患的血管狭窄程度均较介入前明显改善,造影检查结果显示其中残余狭窄程度在20%~40%的有21例,20%以下的有71例,介入治疗过程中和术后不良反应较少,术中2例出现血压下降,3例心率失常,术后随访12个月无患者发生脑血管病事件;内科常规治疗随访12个月内有17例患者反生脑血管病事件,发病率为30.91%,14例为短暂性脑缺血发作,有3例患者为突发脑梗死亡。治疗组与对照组患者的发病率比较,差异有统计学意义（P〈0.05）。结论血管内支架成形术或内科常规治疗可明显降低脑卒中发生率和死亡率并且能提高患者生存质量,但内科常规治疗对于严重的血管狭窄患者,疗效不理想。

Objective To compare the recent therapy effect of interventional therapy and simple medical treatment on ischemic cerebrovascular diseases. Methods Clinical and iconography data of 148 ischemic cerebrovascular patients who diagnosed with DSA, CT or MI and clinically diagnosed from March 2010 to October 2014 of department of neurology and department of invasive technology of our hospital were retrospectively analyzed.Among that,92 conducted stent-assisted angioplasty were designated as therapy group, and the other 56 cases who conducted with routine simple medical treatment were designated as control group.All cases were followed up for 12 months.The therapy effect and incidence condition of adverse reaction were compared between interventional therapy and medical treatment. Results All of 92 cases in therapy group were successful placement stents.Vascular stenosis degree of all patients obvious improved compared with before intervention.Angiography findings indicated that residual stenosis degree between 20% and 40%was 21 cases, less than 20% was 71 cases.There was little adverse during reaction Interventional therapy and postoperative, 2 cases occurred blood pressure decline during operation,3 cases occurred arrhythmia, and no cerebrovascular disease happened among patients in postoperative follow-up for 12 months.7 cases happened cerebrovascular disease in medical treatment group in postoperative follow-up for 12 months and the morbidity was 30.91%, 14 cases were transient ischemic attack and 3 cases were sudden cerebral infarction death.There morbidity had statistical difference between therapy group and control group patients（P〈0.05）. Conclusion Using endovascular stent angioplasty or routine medical treatment can obvious decrease the occurrence rate and death rate of stroke and enhance the life quality of patients. But for patients with severe vascular stenosis,the routine medical treatment effect is unsatisfactory.