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

摘要/Abstract

摘要： 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。

关键词: 颈动脉狭窄, 脑梗死, 颈动脉支架置入术, 脑血流动力学, 认知功能

Abstract: Objective To investigate the application effect 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. Twenty-five 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 flow velocity (Vs), mean blood flow 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 difference was statistically significant (P<0.05). The recurrence rate of cerebral infarction in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion Carotid artery stenting can effectively 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, effective prevention of recurrence of cerebral infarction.

Key words: carotid artery stenosis, cerebral infarction, carotid artery stenting, cerebral hemodynamics, cognitive function

中图分类号:

R743

李延可, 王廷瑞, 陈艳荣, 李晓, 张玉倩. 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[J]. 中华养生保健, 2023, 41(1): 12-15.

LI Yan-ke, WANG Ting-rui, CHEN Yan-rong, LI Xiao, ZHANG Yu-qian. Effect of Carotid Stents on Cerebral Hemodynamics and Neural Function in Patients with Acute Cerebral Infarction[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(1): 12-15.

参考文献

[1] 李涛,许自强,尤书德.急性脑梗死SolitaireAB型支架取栓术中应用替罗非班的临床疗效观察[J].中西医结合心脑血管病杂志,2020,18(16):2704-2707.
[2] 孟军鹏,孟林.颈动脉支架植入术对症状性颈动脉狭窄患者血清炎症因子及认知功能影响的临床研究[J].陕西医学杂志,2020,49(7):796-799.
[3] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018, 51(9):666-682.
[4] 李楠,杨光辉,石斌.美国国立卫生研究院卒中量表评分与颅内自发性脑出血影像不匹配患者神经内镜锁孔手术治疗的疗效评估[J].中国药物与临床,2019,19(11):1859-1861.
[5] 吕艳,张增强,王海,等.海南版简易智能状态检查量表和蒙特利尔认知评估量表界值划分的初步研究[J].中华老年心脑血管病杂志,2020,22(4):352-355.
[6] 张立秀,刘雪琴.蒙特利尔认知评估量表中文版的信效度研究[J].护理研究,2007,21(31):2906-2907.
[7] 李凌江,杨德森,周亮,等.世界卫生组织生活质量问卷在中国应用的信度及效度研究[J].中华精神科杂志,2003,36(3):143-147.
[8] 袁山旗,赵红敏,张西安,等.机械支架介入取栓联合静脉溶栓治疗老年急性脑梗死临床疗效及对患者神经功能的影响[J].陕西医学杂志,2019,48(2):237-240,247.
[9] 王立鹤,田小溪,付国强,等.阿替普酶溶栓治疗对老年急性脑梗死患者炎症因子、颅内血流动力学及神经功能的影响[J].海南医学,2020,31(24):3152-3155.
[10] 代鸣明,苏庆杰,龙发青,等.颈动脉支架置入术对脑梗死患者脑血流动力学变化的随访观察及与临床预后的相关性分析[J].卒中与神经疾病,2019,26(1):51-54.
[11] 吴积宝,姚晓喜,冯刚华,等.支架置入术治疗急性脑梗死合并自发性脑凸面蛛网膜下腔出血一例报道[J].中华神经医学杂志,2021, 20(2):196-197.
[12] 白永杰,张帅,李顺,等.静脉溶栓联合颈动脉支架置入术在急性前循环大血管串联性闭塞卒中患者机械取栓治疗中的安全性和有效性分析[J].中国脑血管病杂志,2019,16(9):449-455.

[1]	王秀平. 芪芍护脑荣筋胶囊联合针刺对急性脑梗死的治疗效果及对远期神经功能影响[J]. 中华养生保健, 2024, 42(9): 24-27.
[2]	汲晶, 李景春. 脑梗死患者脑脊液溶血磷脂酸水平与神经功能缺损状态的相关性分析[J]. 中华养生保健, 2024, 42(9): 44-48.
[3]	雷婷, 薛琳. 平衡运动训练联合认知刺激治疗对脑卒中偏瘫患者平衡能力、认知及下肢功能的影响[J]. 中华养生保健, 2024, 42(9): 68-71.
[4]	孙欢欢. 依达拉奉联合阿托伐他汀治疗脑梗死恢复期患者的相关研究[J]. 中华养生保健, 2024, 42(9): 187-190.
[5]	杨乾乾, 苗素云. 血塞通联合倍他司汀对脑供血不足性眩晕者脑血流、D-D、ET-1、NO水平的影响[J]. 中华养生保健, 2024, 42(6): 37-40.
[6]	王焕. 穴位按摩联合认知干预训练对脑卒中认知功能障碍患者的干预效果[J]. 中华养生保健, 2024, 42(5): 64-66.
[7]	陈西良, 齐强元. 腰硬联合麻醉与气管插管全身麻醉对老年泌尿外科手术患者术后认知功能障碍的比较[J]. 中华养生保健, 2024, 42(4): 11-14.
[8]	刘君会. 耳穴压豆联合中医情志护理对脑梗死后抑郁患者负性情绪及神经功能的影响[J]. 中华养生保健, 2024, 42(3): 32-34.
[9]	李锦娟, 梁新杰, 袁焕宁, 梁逸. 规范化护理在恢复期脑梗塞患者护理中的效果及护理满意度观察[J]. 中华养生保健, 2024, 42(3): 145-148.
[10]	刘现锋. 头针联合镜像疗法对脑梗死偏瘫患者上肢运动功能及日常生活能力的改善效果分析[J]. 中华养生保健, 2024, 42(2): 28-31.
[11]	王迎春. 针刺联合偏瘫肢体康复训练对脑梗死后偏瘫患者疗效分析[J]. 中华养生保健, 2024, 42(2): 68-70.
[12]	豆建刚, 安丽. 多模影像指导下超时间窗动脉取栓术治疗急性脑梗死对NIHSS及mRS评分的效果观察[J]. 中华养生保健, 2024, 42(2): 176-178.
[13]	王鹤鸣. 颈部血管超声对急性脑梗死的检查价值[J]. 中华养生保健, 2024, 42(2): 191-193.
[14]	姚慧娟. 基于跨理论模型的分级干预在脑梗死溶栓治疗后患者中的应用[J]. 中华养生保健, 2024, 42(1): 154-158.
[15]	郑国彬, 徐旭, 袁朝明, 李佩云. 丁苯酞对急性重症脑梗死患者凝血和神经功能的影响[J]. 中华养生保健, 2024, 42(1): 165-167.