静脉溶栓和机械取栓治疗急性大脑中动脉M2段闭塞的效果及预后影响因素分析

Effect of Intravenous Thrombolysis and Removing Embolus Mechanically in the Treatment of Acute Middle Cerebral Artery M2 Segment Occlusion and Analysis of Prognosis Influencing Factors

目的:探讨机械取栓治疗急性大脑中动脉M2段(M2 segment of middle cerebral artery,MCA-M2)闭塞的效果,分析预后不良影响因素。方法:选取高州市人民医院神经内科2019年2月-2021年2月收治的急性MCA-M2闭塞患者70例。按照随机数字表法将其分为溶栓组和取栓组,每组35例。治疗前,检测所有患者空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平。溶栓组接受阿替普酶静脉溶栓治疗,取栓组积极实施机械取栓治疗。比较两组临床疗效,包括美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、血管再通情况、出血转化及预后情况。对急性MCA-M2闭塞患者预后不良的影响因素进行单因素及多因素分析。结果:取栓组治疗后1、7 d NIHSS评分下降≥4分占比高于溶栓组,预后良好率高于溶栓组(P<0.05),两组症状性颅内出血及无症状性颅内出血率比较差异无统计学意义(P>0.05)。取栓组血管再通31例(88.57%)。随访90 d显示患者预后良好共45例(良好组),预后不良25例(不良组)。良好组入院时NIHSS评分低于不良组,机械取栓率高于不良组(P<0.05)。Logistic回归分析显示,入院时NIHSS评分高是急性MCA-M2闭塞患者预后不良的独立危险因素,采用机械取栓是预后不良的保护因素(P<0.05)。结论:机械取栓有利于改善神经功能缺损症状,提高90 d预后良好率,治疗急性MCA-M2闭塞效果显著,安全性与静脉溶栓相当。入院时NIHSS评分高是急性MCA-M2闭塞患者预后不良的独立危险因素,采用机械取栓是预后不良的保护因素。

Objective:To investigate the effect of removing embolus mechanically in the treatment of acute M2 segment of middle cerebral artery (MCA-M2) occlusion,and to analyze the influencing factors of poor prognosis.Method:A total of 70 patients with acute MCA-M2 occlusion treated in the department of neurology of the People’s Hospital of Gaozhou City from February 2019 to February 2021 were selected.They were divided into thrombolysis group and removing embolus group according to the random number table method,with 35 cases in each group.Before treatment,the levels of fasting blood glucose,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol of all patients were measured.The thrombolysis group received intravenous thrombolysis treatment with Alteplase,and the removing embolus group actively implemented removing embolus mechanically treatment.The clinical effects of the two groups were compared,including National Institute of Health stroke scale (NIHSS) score,vascular recanalization condition,bleeding transformation and prognosis condition.The influencing factors of poor prognosis in patients with acute MCA-M2 occlusion were analyzed by univariate and multivariate analysis.Result:The proportion of NIHSS score decreased by ≥4 points in the removing embolus group 1 and 7 days after treatment was higher than that in the thrombolysis group,and the good prognosis rate was higher than that in the thrombolysis group (P<0.05).There was no significant difference in the rates of symptomatic intracranial hemorrhage and asymptomatic intracranial hemorrhage between the two groups (P>0.05).31 cases (88.57%) in the thrombectomy group were recanalized.The follow-up for 90 days showed that the prognosis was good in 45 cases (the good group) and the prognosis was poor in 25 cases (the bad group).The NIHSS score at admission of the good group was lower than that of the bad group,and the removing embolus mechanically rate was higher than that of the bad group (P<0.05).Logistic regression analysis showed that the high NIHSS score at admission was an independent risk factor for poor prognosis in patients with acute MCA-M2 segment occlusion,and mechanical thrombectomy was a protective factor for poor prognosis (P<0.05).Conclusion:Removing embolus mechanically is beneficial to improve the symptoms of neurological function defects,improve the rate of good prognosis in 90 days,and the effect of treatment of acute MCA-M2 occlusion is significant,and the safety is similar to that of intravenous thrombolysis.The high NIHSS score at admission is an independent risk factor for poor prognosis in patients with acute MCA-M2 segment occlusion,and mechanical thrombectomy is a protective factor for poor prognosis.