静脉溶栓桥接支架取栓术对急性缺血性脑卒中患者近期疗效及炎症反应的影响

Effects of bridging stent thrombectomy combined with intravenous thrombolysis on short-term efficacy and inflammatory response in patients with acute ischemic stroke

目的探讨静脉溶栓桥接支架取栓术对急性缺血性脑卒中(AIS)患者近期疗效及炎症反应的影响。方法选取2018年5月至2021年5月重庆大学附属涪陵医院神经内科收治的120例AIS患者,按随机数字表法分为对照组和观察组,每组各60例。对照组采用阿替普酶静脉溶栓,观察组采用阿替普酶静脉溶栓基础上桥接Solitaire AB支架取栓。比较两组患者改良脑梗死溶栓(mTICL)分级、美国国立卫生院卒中量表(NIHSS)评分、改良Rankin表(mRS)评分、血清炎性细胞因子及并发症情况。结果治疗后3 d,观察组血管再通率明显高于对照组(χ^(2)=19.172,P<0.01);治疗1个月后,两组患者NIHSS及mRS评分较治疗前明显降低(P<0.05),且观察组明显低于对照组(t=-5.051、-2.736,P<0.05);治疗1个月后,两组患者神经肽Y(NPY)、S100β、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平较治疗前明显降低(P<0.05),且观察组明显低于对照组(t=-5.794、-5.745、-8.807、-2.615,P<0.05);治疗1个月后,观察组并发症发生率明显低于对照组(χ^(2)=4.910,P<0.05)。结论阿替普酶静脉溶栓后桥接Solitaire AB支架取栓治疗可有效提高AIS患者血管再通率及神经功能,减轻患者炎症反应,同时并发症发生情况较少,疗效安全可靠。

Objective To investigate the effects of bridging stent thrombectomy combined with intravenous thrombolysis on the short-term efficacy and inflammatory responses in patients with acute ischemic stroke(AIS).Methods A total of 120 AIS patients admitted to Fuling Hospital Affiliated to Chongqing University from May 2018 to May 2021 were selected and divided into the control group and observation group according to the random number table,with 60 cases in each group.Patients in the control group were treated by intravenous thrombolysis with alteplase,and patients in the observation group were treated with bridging Solitaire AB stent thrombectomy on the basis of alteplase.The modified thrombolysis in cerebral infarction(mTICL)classification,National Institutes of Health Stroke Scale(NIHSS)score,modified Rankin Scale(mRS)score,serum inflammatory cytokines and complications of the two groups were compared.Results 3 d after treatment,the blood vessel recanalization rate in the observation group was apparently higher than that in the control group(χ^(2)=19.172,P<0.01).After 1 month of treatment,the NIHSS and mRS scores of the two groups were lower than those before treatment(P<0.05),and the observation group were apparently lower than those in the control group(t=-5.051,-2.736;P<0.05).After 1 month of treatment,the levels of neuropeptide Y(NPY),S100β,tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the two groups were apparently lower than those before treatment(P<0.05),and the observation group were apparently lower than those in the control group(t=-5.794,-5.745,-8.807,-2.615;P<0.05).After 1 month of treatment,the incidence of complications in the observation group was significantly lower than that in the control group(χ^(2)=4.910,P<0.05).Conclusion Bridging Solitaire AB stent thrombectomy after intravenous thrombolysis with alteplase can effectively improve the recanalization rate and neurological function of AIS patients and reduce the inflammatory response of patients with fewer complication,which indicates the safety and reliability of the treatment.