药物联合血管内治疗对椎基底动脉闭塞患者的有效性及安全性研究

Efficacy and Safety of Medical Therapy plus Endovascular Treatment in Patients with Vertebrobasilar Artery Occlusion

背景研究证实,血管内治疗可以明显改善急性前循环大血管闭塞患者临床预后,但其治疗后循环大血管闭塞的有效性及安全性目前尚未完全明确。目的探讨药物联合血管内治疗对椎基底动脉闭塞患者的有效性及安全性。方法本研究为回顾性研究。选取2016年1月—2019年5月南阳市中心医院收治的椎基底动脉闭塞患者67例,根据治疗方案不同分为药物治疗组(n=34)和联合治疗组(n=33)。药物治疗组患者给予常规脑梗死药物治疗,联合治疗组患者在常规脑梗死药物治疗基础上联合血管内治疗。比较两组患者入院时及出院后美国国立卫生研究院卒中量表(NIHSS)评分、术后90 d预后(分为预后良好和预后不良);并记录两组患者治疗期间症状性颅内出血、脑疝发生率及术后90 d病死率。结果两组患者入院时、出院后NIHSS评分及预后良好者所占比例比较,差异均无统计学意义(P>0.05)。两组患者治疗期间症状性颅内出血、脑疝发生率及病死率比较,差异无统计学意义(P>0.05)。结论药物联合血管内治疗对椎基底动脉闭塞患者的临床疗效与单纯药物治疗相似,故认为血管内治疗尚不能改善椎基底动脉闭塞患者神经功能及预后,但其安全性较高。

Background Endovascular treatment(EVT)can significantly improve the clinical prognosis of patients with acute anterior circulation large vessel occlusion(LVO);however,the efficacy and safety of EVT in patients with posterior circulation LVO are not fully determined.Objective To investigate the efficacy and safety of medical therapy combined with EVT in patients with vertebrobasilar artery occlusion(VBAO).Methods This retrospective study included 67 VBAO patients in Nanyang Central Hospital from January 2016 to May 2019,and they were divided into medical treatment group(n=34)and combined treatment group(n=33)according to different treatment options.The patients in the medical treatment group were given conventional drug treatment for cerebral infarction,and those of the combined treatment group underwent EVT based on conventional drug treatment.The NIHSS scores at admission and after discharge,the prognosis 90 days after operation(including good prognosis and poor prognosis)were compared between the two groups.The rates of symptomatic intracranial hemorrhage,cerebral hernia and mortality 90 days after operation of the two groups were recorded.Results There was no significant difference in NIHSS scores at admission and after discharge,and the proportion of good prognosis between the two groups(P>0.05).There was no significant difference in rates of symptomatic intracranial hemorrhage,cerebral hernia,and mortality between both groups(P>0.05).Conclusion This study suggests that the efficacy of medical therapy plus EVT is similar to that of medical therapy alone in patients with VBAO.Therefore,EVT may not improve functional outcomes in such patients,but its safety is acceptable.