伴意识障碍的缺血性脑卒中急诊血管不同再通方案的疗效比较

Comparison of therapeutic effects of different revascularization schemes in patients with ischemic stroke and disturbance of consciousness in emergency department

目的研究伴意识障碍的急性缺血性脑卒中(AIS)患者急诊血管不同再通方案的疗效比较。方法采用回顾性调查研究。选取112例进行早期血管再通治疗的伴意识障碍的AIS患者为研究对象,按治疗方法分为静脉溶栓组、直接介入组和桥接治疗组,分析相关病理因素,观察90 d mRS评分和不良事件。结果伴意识障碍的AIS患者约80%存在颅脑大血管闭塞。静脉溶栓组和桥接治疗组总体预后良好率(20.8%,15/72)低于直接介入组(32.5%,13/40)(P<0.05)。三组患者脑梗死后出血转化率和死亡率的差异无统计学意义。结论AIS合并意识障碍的主要病理因素是颅脑大血管闭塞,早期血管再通方案适宜选择直接血管内介入治疗。

Objective To compare the therapeutic effects of different revascularization schemes in patients with acute ischemic stroke(AIS)and disturbance of consciousness in emergency department.Methods Retrospective study was conducted.One hundred and twelve cases of AIS patients with consciousness disorder treated with early vascular recanalization were selected as the study subjects.According to the treatment methods,they were divided into venous thrombolysis group,intravascular interventional therapy group and bridging therapy group,analyze related pathological factors,and observe the 90 d mRS and adverse events.Results About 80%of the AIS patients with consciousness disorder had large vessel occlusion.The overall good prognosis rate of venous thrombolysis group and bridge treatment group(20.8%,15/72)was lower than that of direct intervention group(32.5%,13/40)(P<0.05).There was no difference in the intracranial haemorrhage morbidity and mortality of cerebral hemorrhage among the three groups.Conclusions Brain large vessel occlusion is the main pathological factor of consciousness disorder in acute ischemic stroke.The early vascular recanalization program is suitable for direct endovascular intervention.