桥接疗法治疗急性缺血性脑卒中临床疗效观察

Clinical curative effect of bridging therapy in the treatment of acute ischemic stroke

目的比较静脉溶栓桥接血管介入(桥接疗法)与直接介入法治疗急性缺血性脑卒中(AIS)患者的临床疗效。方法回顾性分析2020年2~10月于西安交通大学第二附属医院神经内科接受治疗的98例AIS患者的临床资料,其中接受桥接疗法者53例(A组),接受直接介入治疗者45例(B组),比较两组患者治疗后12 h的血管再通率,采用美国国立卫生研究院卒中量表(NIHSS)评分评价两组患者不同时间神经功能,采用改良Rankin评分(mRS)评价两组患者90 d预后情况,并统计两组患者治疗后3个月内不良事件及临床结局。结果治疗后12 h,A组患者的血管再通率为81.13%,明显高于B组的53.33%,差异有统计学意义(P<0.05);A组和B组患者治疗后14 d及3个月的NIHSS评分分别为(10.57±2.80)分、(12.21±3.12)分和(5.26±1.93)分、(7.45±2.39)分,差异均有统计学意义(P<0.05);A组患者90 d的预后良好率为83.02%,明显高于B组的62.22%,差异有统计学意义(P<0.05);两组患者治疗后3个月内颅内出血、牙龈出血、穿刺部位出血、血管再闭塞及临床死亡率比较差异均无统计学意义(P>0.05)。结论相比于直接介入治疗,桥接疗法治疗AIS具有血管再通率高、神经功能恢复好、90 d预后良好率高等优势。

Objective To compare the clinical curative effectsof intravenous thrombolytic bridging and vascular intervention(bridging therapy)and direct intervention in the treatment of acute ischemic stroke(AIS).Methods The clinical data of 98 patients with AIS treated in Department of Neurology,the Second Affiliated Hospital of Xi'an Jiaotong University between February and October 2020 were retrospectively analyzed.Among them,53 patients received bridging therapy(group A)and 45 patients received direct intervention(group B).The vascular recanalization rate at 12 h after treatment was compared between the two groups.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate neurological function,and the modified Rankin Scale(mRS)was used to evaluate 90-day prognosis.Adverse events and clinical outcomes between the two groups within 3 months after treatment were counted.Results At 12 h after treatment,the vascular recanalization rate in group A was 81.13%,which was higher than 53.33% in group B,P<0.05.At 14 d and 3 months after treatment,the NIHSS scores of group A and group B were(10.57±2.80)points and(12.21±3.12)points,and(5.26±1.93)points and(7.45±2.39)points,with statistically significant differences(P<0.05).The excellent and good rate of 90-day prognosis in group A was 83.02%,which significantly higher than 62.22% in group B(P<0.05).There were no significant difference in intracranial hemorrhage,gingival hemorrhage,puncture site hemorrhage,reocclusion of blood vessels and clinical mortality between the two groups within 3 months after treatment(P>0.05).Conclusion Compared with direct intervention,bridging therapy for AIS has the advantages of high vascular recanalization rate,good recovery of neurological function,and good prognosis at 90 d.