经颅多普勒超声在急性缺血性脑卒中血管内治疗的临床应用研究

Clinical application of transcranial doppler ultrasonography in endovascular treatment for acute ischemic stroke

目的探讨经颅多普勒超声(TCD)动态监测在急性缺血性脑卒中动脉内治疗的临床应用,及其与预后的关系。方法对2011年5月至2016年6月在卒中中心进行血管内治疗的150例急性缺血性脑卒中患者,进行TCD动态监测;采用缺血性脑卒中溶栓(thrombolysis in brain ischemia,TIBI)分级评分体系评估术前、术后24 h、72 h的血流状况。根据发病后90 d改良Rankin量表(mRS)评分评定患者的预后,mRS评分≤2为预后良好,>2为预后不良。比较不同预后患者之间的各临床指标,并用多因素Logistic回归分析影响预后的因素。结果本组患者中,动脉内治疗后24 h再通115例(77.0%),72 h再通97例(65.0%);预后良好者95例(63.3%),预后不良者55例(36.7%)。预后良好组与预后不良组之间年龄、心脏病史、入院基线NIHSS评分、初治时间、72 h再通率比较,差异均有统计学意义(P<0.05~0.001)。多因素Logistic回归分析示,基线NIHSS评分、初治时间及术后72 h再通率与预后相关。结论 TCD监测在急性缺血性脑卒中血管内治疗有显著的临床意义;基于TCD监测评估的血管72 h再通率是临床转归的保护因素。

Objective To investigate the transcranial doppler ultrasonography in monitoring blood stream of cerebral vessels after endovascular treatments for acute ischemic stroke and the relationship between the prognosis and blood stream on basis of TCD.Methods 150 acute ischemic stroke patients who underwent endovascular treatments from May 2011 to June 2016 were studied retrospectively.All patients were monitored by TCD before operation,24 hours and 72 hours after operation on the basis of the score thrombolysis in brain ischemia（TIBI） of TCD.According to modified Rankin score（mRS,≤2 or 〉 2）,all patients were divided into 2 groups,i.e.favourable and unfavourable outcome.The clinical data of different groups were analyzed.The multivariable Logistic regression analysis were performed to analyze the related prognosis factors.Results In this study,the patients of recanalization of 24 hours was 115（77.0%）.The recanalization of 72 hours was 97（65.0%）.The favourable outcome was 95（63.3%） and unfavourable outcome was 55（36.7%）.The mean age,the heart disease history,the baseline admission NIHSS score,the mean time getting treatment,the rate of recanalization 72 hours after operation were significantly different between 2 groups.In multivariable Logistic regression analysis,the baseline admission NIHSS score,the mean time getting treatment and the rate of recanalization 72 hours after operation were related with prognosis.Conclusions The monitoring of TCD is efficient tool after endovascular treatments in acute ischemic stroke.The recanalization rate of 72 hours on basis of TCD is predictor for favourable outcome.