急性脑梗死行机械支架介入取栓联合静脉溶栓的效果分析

Analysis of the effect of mechanical stent interventional thrombectomy combined with intravenous thrombolysis on acute cerebral infarction

目的 分析急性脑梗死(ACI)行机械支架介入取栓联合静脉溶栓的效果。方法 回顾性分析2020年1月至2021年4月于河北中石油中心医院治疗的116例ACI病人的临床资料,利用SPSS 19.0软件对病人实施1∶1倾向性评分匹配(PSM),最终将行阿替普酶静脉溶栓治疗(溶栓组,n=47)及在其基础上实施机械支架介入取栓(联合组,n=48)的病人作为研究对象。比较两组疗效、即刻血管再通率、神经功能、脑血流动力学指标、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛]、阿替普酶用量、并发症发生率及预后情况。结果 联合组即刻血管再通率、治疗1个月后总有效率分别为91.67%(44/48)、93.75%(45/48),明显较溶栓组的72.34%(34/47)、76.60%(36/47)高(P<0.05);治疗后两组CSS评分及血清丙二醛水平和治疗前相比均明显降低(P<0.05),且联合组均明显较溶栓组低(均P<0.05);治疗后1个月两组血清SOD水平和治疗前相比均明显升高(均P<0.05),且联合组均明显较溶栓组高(P<0.05);治疗后1个月两组发病部位位于大脑半球的病人的大脑中动脉血流最大峰值流速(Vs)、血管阻力指数(RI)及位于脑干、小脑的病人的双侧椎动脉(VA)及基底动脉(BA)和治疗前相比均明显改善(P<0.05),且联合组改善情况均明显较溶栓组优(P<0.05);联合组阿替普酶用量明显较溶栓组少(P<0.05),并发症发生率明显较溶栓组低(P<0.05);治疗后3个月,联合组GOS分级情况明显较溶栓组优(P<0.05)。结论 对ACI病人实施机械支架介入联合阿替普酶静脉溶栓治疗的效果较佳,可明显改善氧化应激指标及脑血流动力学,显著降低神经功能缺损程度,有效减少并发症的发生,同时有利于病人获得理想预后。

Objective To analyze the effect of mechanical stent interventional thrombectomy combined with intravenous thrombolysis in acute cerebral infarction(ACI).Methods The clinical data of 116 patients with ACI treated in Hebei CNPC Central Hospital from January 2020 to April 2021 were retrospectively analyzed. The patients were matched with 1:1 propensity score(PSM) by SPSS 19.0 software. Finally, the patients who underwent intravenous thrombolytic therapy with alteplase(thrombolytic group, n=47) and mechanical stent interventional thrombectomy(combined group, n=48) were taken as the research objects. The curative effect, immediate vascular recanalization rate, neurological function, cerebral hemodynamic indexes, oxidative stress indexes [superoxide dismutase(SOD), malondialdehyde], alteplase dosage, complication rate and prognosis of the two groups were compared.Results The immediate vascular recanalization rate and the total effective rate after one month of treatment in the combined group were 91.67%(44/48) and 93.75%(45/48) respectively, which were significantly higher than 72.34%(34/47) and 76.60%(36/47) in the thrombolytic group(P<0.05);after treatment, the CSS scores and serum malondialdehyde levels of the two groups were significantly lower than those of before treatment(P<0.05), and the combined group were significantly lower than the thrombolysis group(all P<0.05);one month after treatment, the serum SOD levels in the two groups were significantly higher than those before treatment in the same group(all P<0.05), and the combined group were significantly higher than the thrombolysis group(P<0.05);One month after treatment, the maximum peak flow velocity(VS), vascular resistance index(RI) of middle cerebral artery in patients with cerebral hemisphere, the bilateral vertebral artery(VA) and basilar artery(BA) in patients with brainstem and cerebellum were significantly improved compared with those before treatment(P<0.05), and the improvement in the combined group was significantly better than that in the thrombolytic group(P<0.05);the dosage of alteplase in the combined group was significantly less than that in the thrombolytic group(P<0.05);after treatment, the incidence of complications in the combined group was significantly lower than that in the thrombolytic group(P<0.05);3 months after treatment, the GOS grade of the combined group was significantly better than that of the thrombolytic group(P<0.05).Conclusion The effect of mechanical stent intervention combined with intravenous thrombolysis with alteplase in patients with ACI is better, which can significantly improve the index of oxidative stress and cerebral hemodynamics, significantly reduce the degree of neurological deficit, effectively reduce the occurrence of complications, and help patients obtain ideal prognosis.