急性缺血性腦卒中血管內介入治療回顧分析

Retrospective clinical analysis of endovascular recanalization in acute ischemic stroke

目的研究鏡湖醫院急性缺血性腦卒中血管內介入治療的有效性及安全性,查找其中綠色通道流程的不足,並提出改進的方案。方法通過回顧2010年中国澳門鏡湖醫院開展急性缺血性腦卒中血管內介入治療以來6年連續58例的情况,包括起病到血管再通時間,血管再通率,3個月時病人轉歸,症狀性出血率及死亡率,以國際指南對照及與先進地區作對比。結果共有58位腦卒中病人接受血管內介入治療。血管再通率為81%,血管再通時中位數為274分鐘,有徵狀出血率為6.9%,modified Rankin Score 0~2佔61%,死亡率為10%。結論鏡湖醫院急性缺血性腦卒中血管內介入治療治療技術效果及安全性達到國際先進水平,但在診治流程設計及執行上存在不足,導致溶栓率低,影響治療轉歸,應根據國際指南設計及改進流程,以獲得更好的治療效果。

Objective To investigate the efficacy and safety of endovascular recanalization in acute ischemic stroke;and the impact of delay in the fast track response in treating stroke patients.Methods The authors retrospectively reviewed their acute ischemic stroke cases treated with endovascular recanalization from 2010 to 2015.The recanalization rate,onset to recanalization time,symptomatic bleeding rate and outcome of the patiens were analyzed.Results A total of 58 cases of acute ischemic stroke received endovascular treatment.The recanalization rate was 81%,median onset to recanalization time was 274 minutes,symptomatic bleeding rate was 6.9%,modified Rankin Score 0-2 was 61%,mortality rate was 10%.Conclusion The endovascular recanalization intervention carried out in Kiangwu Hospital is an effective and safe treatment for acute ischemic stroke patients.There were still inadequacies in the patient flow design which had led to low utilization of thrombolytic therapy.Patient results were negatively affected.Further modification of the fast track algorithm with reference to international guidelines will further improve the treatment outcome.