急性缺血性脑卒中患者支架取栓临床分析

Clinical analysis of stent thrombectomy for patients with acute ischemic stroke

目的探讨超选择动脉溶栓联合支架取栓(联合组)与支架取栓(支架组)在急性缺血性脑卒中(AIS)患者中的有效性、安全性及适用性。方法收集2016-01—2017-03在石河子大学医学院第一附属医院治疗的AIS患者,联合组25例,支架组15例,观察2组NIHSS评分、GCS评分变化情况,脑血管再通情况、并发症情况、90d内病死率、90d后改良mRs评分。结果AIS患者行支架取栓治疗再通率达100%,行穿刺到血管再通时间联合组明显长于支架组(Z=-3.670,P=0.000),支架组术后第1天病情好转情况,GCS评分差异无统计学意义(Z=-1.749,P=0.080),NIHSS评分差异无统计学意义(Z=-1.516,P=0.129),联合组术后病情好转情况,GCS评分差异有统计学意义(Z=-2.749,P=0.005),NIHSS评分差异有统计学意义(Z=-2.863,P=0.004)。2组术后7d病死率差异无统计学意义(χ~2=0.01,P=0.92),90d内病死率差异无统计学意义(χ~2=0.01,P=0.93),90d预后良好,差异无统计学意义(χ~2=0.00,P=1.00)。结论超选择动脉溶栓联合支架取栓与支架取栓均可以治疗急性缺血性脑卒中;支架取栓对于治疗大动脉血管闭塞再通率高;短期内联合治疗相比支架取栓能够更有效改善患者术后病情,但2组治疗方案长期预后情况无差异。

Objective To explore the efficacy, safety and applicability by arterial thromholysis combined with stent throm- bectomy （combined group） or stent thrombectomy （stent group） in the treatment of acute ischemic stroke （AIS）. Methods We had received AIS patients＇ information who gained treatment in our department during the period from January 2016 to March 2017,including 25 cases of combined group, and 15 cases of stent group. The changes of NIHSS score and GCS score of two groups, cerebral vascular recanalization, complications, 90d＇s mortality, 90d＇s mRS score between the two groups were compared. Results The recanalization rate of AIS patients treated by stent thrombectomy was 100%. The time from puncture to recanaliza- tion was significantly longer in combined group than stent group （Z = 3. 670, P= 0. 000）. One day after surgery, the GCS scores and NIHSS scores in the sent group showed no difference compared to that before the surgery. While in the combined group,GCS score and NIHSS score were changed significantly. There was no statistical difference in the 7 days mortality, 90 days mortality and prognosis 90 days after surgery between the two groups. Conclusion I.t is an effective way to treat AIS patients by arterial thrombolysis and stent thrombeetomy. The recanalization rate is high by stent thrombectomy in the treatment of large artery oc- clusion. It is more effectively in combined group than stent group in the short term, but there is no difference in prognosis between the two groups in long-term.