血管内介入与单纯药物治疗缺血性脑血管病的效果比较

Comparison between endovascular intervention and medicine therapy in treatment of ischemic cerebrovascular disease

目的比较血管内介入与单纯药物治疗缺血性脑血管病的临床疗效与安全性。方法 89例缺血性脑血管病患者分为介入组42例和药物组47例,介入组采用介入手术治疗,药物组单纯给予阿司匹林、氯吡格雷、阿托伐他汀等药物治疗,比较两组患者主要责任血管血流改善情况及随访期间脑血管事件发生率及病死率。结果治疗后3个月、12个月介入组颈总动脉、颈内动脉、椎动脉、基底动脉均较治疗前有明显改善,差异有统计学意义(P<0.05),而药物组未见明显改善(P>0.05)。介入组治疗后3个月、12个月的颈总动脉、颈内动脉、椎动脉、基底动脉均明显低于同时间点的对照组,两组比较,差异有统计学意义(P<0.05)。介入组治疗后3个月、治疗后12个月脑血管病事件发生率均低于药物组,两组比较,差异均无统计学意义(P>0.05)。两组治疗后3个月均无死亡病例,治疗后12个月药物组死亡2例(4.26%),两组比较,差异无统计学意义(P>0.05)。结论相对单纯药物治疗而言,血管内介入治疗缺血性脑血管病能获得更好的临床效果,安全性较高。

Objective To compare the clinical effect and safety of endovascular intervention and simple medicine therapy in treatment of ischemic cerebrovascular disease. Methods A total of 89 patients with isehemic cerebrovascular disease were divided into intervention group（ n = 42） and medicine group （n = 47 ）. Patients in intervention group were treated with endovascular intervention; Patients in medicine group were treated with drugs such as aspirin, clopidogrel and atorvastatin. The improvement of blood flow of primary responsible vascular and the incidence rate, mortality rate of cerebrovascular events in follow-up period were compared between two groups. Results Compared with before treatment, the systolic peak flow velocity of common carotid artery, internal carotid artery, vertebral artery and basilar artery were significantly improved at 3 months and 12 months after treatment in the intervention group （ P 〈 0.05 ）, but there was not obviously improved in the medicine group（P 〈 0.05 ） . The systolic peak flow velocity of common carotid artery, internal caritid artery, vertebral artery and basilar artery at 3 months and 12 months after treatment in the intervention group were significantly lower than the same time point of the medicine group （P 〈 0.05 ） ; the incidence rate of cerebmvascular events at 3 months and 12 months after treatment in the intervention group were lower than that of the medicine group, but the difference had no statistical significance （ P 〉 0.05 ）. There was no significant difference of the mortality rate between the two groups （P 〉 0.05 ）. Conclusion Compared with simple medicine treatment, endovascular intervention can achieve better clinical effect and safety in treatment of ischemie cerebrovascular disease.