支架机械取栓与动脉溶栓对中重度急性脑梗死患者血管再通、神经功能及预后的影响研究

Effect Comparison of Stent Retriever-based Thrombectomy and Arterial Thrombolysis on Revascularization,Neurological Function and Bleeding in Patients with Moderate to Severe Acute Cerebral Infarction

目的分析支架机械取栓与动脉溶栓对中重度急性脑梗死(acute cerebral infarction,ACI)患者血管再通、神经功能及预后的影响。方法选取衡水市第六医院2015年1月—2017年2月收治的116例中重度ACI患者,按照治疗方式的不同分为研究组与对照组各58例,对照组患者给予动脉溶栓治疗,研究组患者给予支架机械取栓治疗。观察分析两组患者术后血管再通率,术前及术后第1、7天简明精神状态量表(mini-mental state examination,MMSE)评分,术后24 h出血率和术前及术后3、6个月改良Rankin量表评分(modified rankin scale,mRS)。结果研究组患者术后血管再通率为84.48%明显高于对照组的63.79%,差异有统计学意义(P<0.01)。术后第1、7天,两组患者MMSE评分均高于术前1 d,且研究组患者MMSE评分亦明显高于对照组患者,差异均有统计学意义(P<0.05或P<0.01)。研究组患者术后24 h出血率为5.17%明显低于对照组患者的22.41%,差异有统计学意义(P<0.01)。术后3、6个月,两组患者mRS评分均明显低于术前,且研究组患者mRS评分明显低于对照组患者,差异均有统计学意义(P<0.05或P<0.01)。结论中重度ACI患者应用支架机械取栓可以早期快速清除病变血管血栓,恢复血流灌注,增加血管再通率,且术后出血并发症发生率较低,安全性较好,对患者术后神经功能的恢复有积极意义。

Objective To analyze the effects of stent retriever-based thrombectomy(SRT)and arterial thrombolysis on revascularization,neurological function and bleeding in patients with moderate to severe acute cerebral infarction(ACI).Methods A total of 116 patients with moderate to severe ACI admitted to Sixth Hospital of Hengshui from January 2015 to February 2017 were divided into research group(n=58)and control group(n=58)according to different treatment methods.Patients in the control group were treated with arterial thrombolysis,and those in the research group were treated with SRT.The postoperative revascularization rate,the mini-mental state examination(MMSE)score before operation and on the 1st and 7th day after operation,postoperative bleeding rate,and the modified Rankin scale score(mRS)before operation and at 3,6 months after operation of the two groups were observed and analyzed.Results The postoperative revascularization rate of the research group was 84.48%,which was significantly higher than 63.79%of the control group(P<0.01).On the 1st and 7th day after operation,the MMSE scores of the two groups were higher than that on the first day before surgery,and the MMSE score of the research group was significantly higher than that of the control group(P<0.05 or P<0.01).The postoperative bleeding rate of the research group was 5.17%,which was significantly lower than 22.41%of the control group(P<0.01).At 3 and 6 months after operation,the mRS scores of the two groups were significantly lower than those before surgery,and the mRS score of the research group was significantly lower than that of the control group(P<0.05 or P<0.01).Conclusion In patients with moderate to severe ACI,the use of SRT can quickly remove thrombosis in diseased blood vessels,restore blood perfusion,and increase the revascularization rate.In addition,it has a lower incidence rate of postoperative bleeding complications and a good safety,and is of positive significance in the recovery of postoperative neurological function.