发病4.5 h内急性大血管闭塞性缺血性脑卒中患者直接取栓及桥接治疗的效果及安全性观察

Observation on the efficacy and safety of direct thrombectomy and bridging therapy in treating patients with acute large vessel occlusive ischemic stroke within 4.5h after onset

目的探讨发病4.5 h内急性大血管闭塞性缺血性脑卒中患者直接取栓及桥接治疗的效果及安全性。方法选择2019年1月—2021年3月本院接诊的80例急性大血管闭塞性缺血性脑卒中患者作为研究对象,按随机数表法分为A组和B组两组,每组各40例。A组采用直接取栓治疗,B组采用桥接治疗。比较两组患者治疗情况、血管再通率、术前及术后14 d美国国立卫生研究院卒中量表(NIHSS)评分的变化,以及术后90 d改良Rankin量表(mRS)评分预后良好率及有症状颅内出血发生率。结果A组患者的入院至穿刺时间明显短于B组,差异有统计学意义(P<0.05);两组患者的穿刺至血管开通时间、取栓次数比较,差异无统计学意义(P>0.05);两组患者的血管再通率比较,差异无统计学意义(P>0.05);两组患者术后14 d的NIHSS评分比较,差异无统计学意义(P>0.05);两组患者术后14 d的NIHSS评分均明显低于术前,差异均有统计学意义(P<0.05);两组患者的术后90 d预后良好率比较,差异无统计学意义(P>0.05);两组患者有症状颅内出血发生率(5.00%,7.50%)比较,差异无统计学意义(P>0.05)。结论直接取栓及桥接治疗对发病4.5 h内急性大血管闭塞性缺血性脑卒中患者的疗效及安全性均较好,但直接取栓的入院至穿刺时间更短。

Objective To study the efficacy and safety of direct thrombectomy and bridging therapy in treating patients with acute large vessel occlusive ischemic stroke within 4.5h after onset.Methods 80 patients with acute large vessel occlusive ischemic stroke those were treated in our hospital from January 2019 to March 2021 were selected as the research objects,they were randomly divided into group A and group B according to random number table method,with 40 cases in each group.Group A was treated with direct thrombectomy and group B was treated with bridgingtherapy.The treatment,vascular recanalization rate,the changes of National Institutes of Health Stroke Scale(NIHSS)score at before surgery and 14 daysafter surgery,and modified Rankin scale(mRS)score at 90dafter surgery,and incidence of symptomatic intracranial hemorrhage were compared between the two groups patients.Results The time from admission to puncture in group A was significantly shorter than that in group B,with statistically significant(P<0.05).There were no statistically significant difference in the time from puncture to vessel opening and the number of thrombolysis between the two groups of patients(P>0.05).There was no significant difference in vascular recanalization rate between group A and group B(P>0.05).There was no statistical significance in the NIHSS score between the two groups at 14 daysafter surgery(P>0.05).The NIHSS scores at 14 daysafter surgery of the two groups of patients were significantly lower than those before surgery,with statistical significance(P<0.05).There was no statistical significant difference in the rate of good prognosis at 90dafter surgery between group A and group B(P>0.05).The incidence of symptomatic intracranial hemorrhage in group A and group B patients were 5.00%and 7.50%,respectively,with no statistical significance(P>0.05).Conclusions Direct thrombectomy and bridging therapy achieves good efficacy and safety in treating patients with acute large vessel occlusive ischemic stroke within 4.5h after onset,but the time from admission to puncture is shorter in patients received direct thrombectomy.