桥接治疗与直接机械取栓治疗大血管闭塞-急性缺血性脑卒中的疗效比较

Comparison of the effect of bridging therapy and direct mechanical thrombectomy on acute ischemic stroke due to large vessel occlusion

目的 比较桥接治疗与直接机械取栓治疗大血管闭塞(LVO)-急性缺血性脑卒中(AIS)的疗效。方法 选取2016年4月至2019年2月在湖州市第一人民医院行血管内介入治疗的100例LVO-AIS患者为研究对象,其中桥接治疗组52例,机械取栓组48例。比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷指数(GCS)评分、有效再通血管比例、预后良好率及并发症发生率。结果 与入院时比较,两组患者治疗3 d及1、2、4周后NIHSS评分均明显降低(均P<0.05),治疗3 d及1周后GCS评分均明显升高(均P<0.05);其中治疗2、4周后桥接治疗组NIHSS评分均明显低于机械取栓组(均P<0.05)。两组患者有效再通血管比例(84.62%比77.08%)、并发症发生率(15.38%比27.08%)比较,差异均无统计学意义(均P>0.05);桥接治疗组患者治疗3个月后预后良好率明显高于机械取栓组(69.23%比47.92%),差异有统计学意义(P<0.05)。结论 与直接机械取栓相比,桥接治疗对LVO-AIS患者神经功能恢复及远期预后更为有利。

Objective To compare the effects of bridging therapy and direct mechanical thrombectomy on acute ischemic stroke( AIS) due to large vessel occlusion(LVO). Methods A total of 100 LVO-AIS patients underwent endovascular interventional therapy in Huzhou First People’s Hospital from April 2016 to February 2019 were included with52 patients in the bridging therapy group and 48 in the mechanical thrombectomy group. The National Institutes of Health stroke scale(NIHSS) score, Glasgow coma scale(GCS) score, the proportion of effective recanalization, the rate of good prognosis and the incidence of complications were compared between the two groups before and after treatment.Results NIHSS score decreased significantly after 3 days and 1, 2, and 4 weeks of treatment(all P<0.05) and GCS scores increased significantly after 3 days and 1 week of treatment(all P<0.05) compared those before treatment in both groups. The NIHSS scores in the bridging therapy group were significantly lower than those in the mechanical thrombectomy group after 2 and 4 weeks of treatment(all P<0.05). There were no significant differences in the ratio of effective recanalization(84.62% vs. 77.08%) and the incidence of complications(15.38% vs. 27.08%) between the two groups(both P >0.05). The ratio of good prognosis was significantly higher in the bridging therapy group than in the mechanical thrombectomy group(69.23% vs. 47.92%, P<0.05). Conclusion Compared with direct mechanical thrombectomy, bridging therapy has a more favorable effect on neurological recovery and long-term prognosis in patients with LVO-AIS.