颈动脉支架置入术对脑梗死患者血流动力学及神经功能的影响

Effect of Carotid Stents on Cerebral Hemodynamics and Neural Function in Patients with Acute Cerebral Infarction

目的探讨颈动脉支架置入术在急性颈内动脉系统脑梗死合并同侧颈内动脉中-重度狭窄患者中的应用效果。方法回顾性分析2019年6月~2021年6月滨州市中心医院收治的40例急性颈内动脉系统脑梗死并同侧颈内动脉中-重度狭窄患者的临床资料,按治疗方式的不同将其分为对照组和观察组。对照组25例患者给予常规双抗+内科基础治疗,观察组15例患者予以常规双抗+内科基础治疗+颈动脉支架置入术治疗,两组均随访6个月。对比两组患者血管狭窄侧脑血流动力学、神经功能、认知功能、生活质量、脑梗死再发情况。结果治疗前,两组阻力指数(RI)、收缩期最大血流速度(Vs)、平均血流速度(Vm)、美国国立卫生研究院卒中量表(NIHSS)、简易智能量表(MMSE)、蒙特利尔认知评估量表(MoCA)、生活质量综合评定问卷(GQOLI-74)内各维度评分比较,差异无统计学意义(P>0.05);治疗后,两组RI、NIHSS评分均低于治疗前,Vs、Vm、MMSE、MoCA和GQOLI-74内各维度评分均高于治疗前,且观察组RI、NIHSS评分低于对照组,Vs、Vm、MMSE、MoCA和GQOLI-74内各维度评分高于对照组,差异均有统计学意义(P<0.05)。观察组脑梗死再发率低于对照组,差异有统计学意义(P<0.05)。结论颈动脉支架置入术可有效改善急性颈内动脉系统脑梗死并同侧颈内动脉中-重度狭窄患者的脑血流动力学,有利于患者神经功能的恢复,改善认知功能及生活质量,有效预防脑梗死的复发。

Objective To investigate the application eff ect of carotid artery stenting in patients with acute internal carotid artery system cerebral infarction and moderate to severe stenosis of ipsilateral internal carotid artery.Methods The clinical data of 40 patients with acute internal carotid system cerebral infarction and ipsilateral internal carotid artery moderate to severe stenosis admitted to Binzhou Central Hospital from June 2019 to June 2021 were retrospectively analyzed into two groups.Twentyfi ve patients who received conventional dual-antibody+basic medical treatment were the control group,and 15 patients who received conventional dual-antibody+basic medical treatment+carotid stent implantation were the observation group.Both groups were followed up for 6 months.The cerebral hemodynamics,neurological function,cognitive function,quality of life and recurrence of cerebral infarction were compared between the two groups.Results Before treatment,resistance index(RI),maximum systolic blood fl ow velocity(Vs),mean blood fl ow velocity(Vm),National Institutes of Health Stroke Scale(NIHSS),Mini-Smart Scale(MMSE),There was no significant difference in the scores of each dimension in Montreal Cognitive Assessment Scale(MoCA)and Quality of Life Comprehensive Assessment Questionnaire(GQOLI-74)(P>0.05).After treatment,the RI and NIHSS scores in the two groups were lower than Before treatment,the scores of each dimension in Vs,Vm,MMSE,MoCA and GQOLI-74 were higher than those before treatment,and the RI and NIHSS scores in the observation group were lower than those in the control group.The score was higher than that in the control group,and the diff erence was statistically signifi cant(P<0.05).The recurrence rate of cerebral infarction in the observation group was lower than that in the control group,and the diff erence was statistically signifi cant(P<0.05).Conclusion Carotid artery stenting can eff ectively improve cerebral hemodynamics in patients with acute internal carotid artery system cerebral infarction and ipsilateral internal carotid artery moderate-severe stenosis,which is beneficial to the recovery of neurological function,improving cognitive function and life.Quality improvement,eff ective prevention of recurrence of cerebral infarction.