静脉溶栓联合Trevo支架机械取栓治疗缺血性脑卒中的疗效及影响因素分析

Analysis of therapeutic effect and prognostic factors of intravenous thrombolysis combined with mechanical thrombectomy with Trevo stent in the treatment of ischemic stroke

目的探究静脉溶栓联合Trevo支架机械取栓治疗缺血性脑卒中的疗效及预后影响因素分析。方法2020年01月~2022年12月收治的缺血性脑卒中病人120例,按随机数表法分为对照组和研究组两组,每组各60例。对照组在时间窗内接受静脉溶栓和动脉溶栓,研究组接受静脉溶栓和Trevo支架机械取栓。观察两组临床疗效,根据预后情况将病人分为预后良好组(46例)和预后不良组(74例),收集两组病人性别、年龄、BMI、合并高血压、合并糖尿病、吸烟、治疗方式、血管完全再通率、术前NIHSS评分、术后NIHSS评分等资料,采用单因素和多因素二元Logistic回归分析影响预后的独立因素。结果研究组总有效88.33%(53/60)显著高于对照组的73.33%(44/60),差异有统计学意义(P<0.05)。单因素分析结果显示,预后良好组、预后不良组两组性别、BMI、合并糖尿病、术前NIHSS评分比较差异无统计学意义(P>0.05),年龄、合并高血压、吸烟、治疗方式、血管完全再通率、术后NIHSS评分比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄、治疗方式、血管完全再通率是影响缺血性脑卒中病人预后的独立因素(P<0.05)。结论静脉溶栓联合Trevo支架机械取栓治疗可以提高静脉溶栓时间窗内的缺血性脑卒中病人临床疗效和预后质量。缺血性脑卒中病人的预后还与病人的年龄和术后血管完全再通率有关。

Objective To explore the effect and prognostic factors of intravenous thrombolysis combined with Trevo stent mechanical thrombectomy in the treatment of ischemic stroke.Methods A total of 120 patients with ischemic stroke diagnosed and treated in our hospital from January 2020 to December 2022 were selected as research objects and divided into two groups according to random number table method,with 60 cases in each group.Both groups were given basic treatment,the control group was given intravenous thrombolytic therapy,and the observation group was given intravenous thrombolytic therapy combined with mechanical thrombectomy with Trevo stent.The clinical efficacy of the two groups was observed,and the patients were divided into a good prognosis group(46 cases)and a poor prognosis group(74 cases)according to the prognosis.Clinical data such as gender,age,BMI,combined hypertension,combined diabetes,smoking,treatment methods,complete vascular recirculation rate,preoperative NIHSS score and postoperative NIHSS score of the two groups were collected.The independent prognostic factors were analyzed by univariate and multivariate binary Logistic regression.Results The total effective rate of the study group was significantly higher 88.33%(53/60)than that of the control group 73.33%(44/60),and the difference was statistically significant(P<0.05).Univariate analysis showed that there were no statistically significant differences in gender,BMI,diabetes mellitus,and preoperative NIHSS score between the two groups(P>0.05),while there were statistically significant differences in age,hypertension,smoking,treatment style,complete vascular revasculosity,and postoperative NIHSS score between the two groups(P<0.05).Logistic regression analysis showed that age,treatment style and complete vascular revasculopathy rate were independent factors affecting the prognosis of ischemic stroke patients(P<0.05).Conclusion Intravenous thrombolysis combined with mechanical thrombectomy with Trevo stent can improve the clinical efficacy and prognostic quality of ischemic stroke patients in the time window of intravenous thrombolysis.In addition,the prognosis of patients with ischemic stroke is also closely related to the age of patients and the rate of complete vascular recirculation after surgery.