早期机械取栓治疗大动脉闭塞性急性脑梗死临床效果及对神经功能恢复影响

Effect of Early Mechanical Thrombectomy in the Treatment of Acute Cerebral Infarction with Large Artery Occlusion and Its Influence on the Recovery of Nerve Function

目的观察早期机械取栓治疗大动脉闭塞性急性脑梗死的临床效果及对神经功能恢复的影响。方法选取大动脉闭塞性急性脑梗死96例,根据治疗方法不同将其分为研究组(49例)和对照组(47例)两组。研究组采用早期机械取栓治疗,对照组采用动静脉联合溶栓治疗。比较两组治疗后3周临床治疗效果,治疗前及治疗后1、3周美国国立卫生研究院神经功能缺损量表(national institute of health stroke scale, NIHSS)评分,治疗前及治疗后3周血清脑源性神经营养因子(BDNF)、神经营养因子(NTF)及血管内皮生长因子(VEGF)水平,治疗3个月后病变残余狭窄率、血管再闭塞率及病死率,以及术后1个月并发症发生情况。结果治疗后3周,研究组临床总有效率91.84%高于对照组临床总有效率72.34%,差异有统计学意义(P<0.05)。治疗前及治疗后1、3周,两组组内不同时间NIHSS评分总体比较差异有统计学意义(P<0.05)。治疗后1和3周,两组NIHSS评分均较治疗前降低;治疗后3周,两组NIHSS评分均较治疗后1周降低,差异有统计学意义(P<0.05)。治疗后1和3周,研究组NIHSS评分均低于对照组,差异有统计学意义(P<0.05)。治疗后3周,两组血清BDNF、NTF及VEGF水平均较治疗前升高,研究组血清BDNF、NTF及VEGF水平均高于对照组,差异有统计学意义(P<0.05)。治疗后3个月,研究组血管再闭塞率低于对照组,差异有统计学意义(P<0.05)。结论早期机械取栓治疗大动脉闭塞性急性脑梗死效果显著,可保护患者神经功能、增加神经保护因子释放,利于神经功能重建,且在降低血管再闭塞率方面有一定优势。

Objective To observe the clinical effect of early mechanical thrombectomy in the treatment of acute cerebral infarction(ACI) with large artery occlusion and its effect on the recovery of nerve function. Methods A total of 96 ACI patients with large artery occlusion were divided into the research group(n=49) and the control group(n=47) according to random number table method. The research group was treated with early mechanical thrombectomy, while the control group was treated with combined arteriovenous thrombolysis. The therapeutic effects of the two groups were compared at 3 weeks after operation. The scores of National Institute of Health Stroke Scale(NIHSS) before treatment and at 1 and 3 weeks after treatment as well as the levels of serum brain-derived neurotrophic factor(BDNF), neurotrophic factor(NTF) and vascular endothelial growth factor(VEGF) before and at 3 weeks after treatment were compared. In addition, the rate of residual stenosis, vascular re-occlusion and mortality at 3 months after treatment, and complications at one month after operation were observed and recorded. Results After 3 months of treatment, the total clinical effective rate of the research group was 91.84%, which was significantly higher than that(72.34%) of the control group(P<0.05). There was a statistically significant difference in NIHSS scores before treatment, and at 1 week and 3 weeks after treatment(P<0.05). The NIHSS scores of the two groups were lower than those before treatment at 1 week and 3 weeks after treatment, which were significantly lower at 3 weeks after treatment in both groups, as compared with those at 1 week after treatment(P<0.05). The NIHSS score of the research group was lower than that of the control group at 1 and 3 weeks after operation, and the difference was statistically significant(P<0.05). After treatment, the levels of BDNF, NTF and VEGF were increased in both groups, which were higher in the research group than in the control group(P<0.05). The re-occlusion rate of blood vessel in the research group was lower than that in the control group at 3 months after treatment, and the difference was statistically significant(P<0.05). Conclusion Early mechanical thrombectomy is effective in the treatment of ACI with large artery occlusion. It can effectively protect the nerve function of patients, increase the release of neuroprotective factors, facilitate the reconstruction of nerve function, and has more advantages in reducing vascular occlusion.