不同血管再通方法在急性脑梗塞患者中的临床疗效评价

中华养生保健 ›› 2023, Vol. 41 ›› Issue (4): 4-7.

不同血管再通方法在急性脑梗塞患者中的临床疗效评价

郑建新^1,*, 张帅杰¹, 孙伟力^2,*

1.漯河医学高等专科学校第二附属医院神经内科,河南漯河, 462300;
2.河南省新乡医学院第二附属医院神经内科,河南新乡, 453002

出版日期:2023-02-16 发布日期:2023-02-16
通讯作者: ^*郑建新,E-mail：15565906333@163.com;孙伟力,E-mail：shufort2005@163.com。
作者简介:郑建新（1979—）,男,汉族,籍贯：河南省许昌市,硕士研究生,主任医师,研究方向：脑血管疾病。
基金资助:
漯河医学高等专科学校科研类项目（2019-LYZKYYB013）

Clinical Evaluation of Different Recanalization Methods in Patients with Acute Cerebral Infarction

ZHENG Jian-xin^1,*, ZHANG Shuai-jie¹, SUN Wei-li^2,*

1. Department of Neurology, The Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, China;
2. Department of Neurology, Second Affiliated Hospital of Xinxiang Medical University Henan Province, Xinxiang Henan, 453002, China

Online:2023-02-16 Published:2023-02-16

摘要/Abstract

摘要： 目的比较静脉溶栓、机械取栓及桥接治疗急性脑梗死的临床疗效。方法选取河南省漯河医学高等专科学校第二附属医院神经内科2016年1月—2019年1月收治的急性脑梗死患者78例,根据不同治疗方法分静脉溶栓组30例,机械取栓组25例,静脉溶栓桥接组23例。分别对各组治疗前、治疗后24 h、治疗后14 d美国国立卫生研究院卒中量表（National Institute of Health stroke scale,NIHSS）评分及治疗后90 d改良Rankin量表（Modified Rankin Scale,mRS）评分进行比较,评估疗效。结果与治疗前相比,机械取栓组、桥接治疗组治疗后24 h、14 d NIHSS评分明显降低（P<0.05）,机械取栓组、桥接治疗组NIHSS评分均低于静脉溶栓组（P<0.05）,而机械取栓组和桥接组治疗后各时间点NIHSS评分相近,差异无统计学意义（P>0.05）。桥接组、机械取栓组90 d后mRS评分明显低于静脉溶栓组,差异有统计学意义（P<0.05）,桥接组与机械取栓组相比,差异无统计学意义（P>0.05）。结论采用静脉溶栓、机械取栓或桥接治疗,均可使急性脑梗死患者神经功能改善,采用机械取栓、桥接治疗对神经功能改善时间较早,远期预后较好。¹

关键词: 急性脑梗死, 静脉溶栓, 机械取栓, 桥接治疗

Abstract: Objective To compare the clinical efficacy of intravenous thrombolysis, mechanical thrombectomy and bridging in the treatment of acute cerebral infarction. Methods From January 2016 to January 2019,78 patients with acute cerebral infarction were selected from the Department of Neurology, the Second Affiliated Hospital of Luohe Medical Higher Vocational School, Henan Province. They were divided into intravenous thrombolysis group (n=30) and mechanical thrombectomy group (n=25) according to different therapeutic methods, venous Thrombolysis Bridging Group (n=23) . The National Institutes of health stroke scale (NIHSS) scores before treatment, 24 hours after treatment, 14 days after treatment and Modified Rankin Scale(mRS) Scores at 90 days after treatment were compared in each group to evaluate the therapeutic effect. The patient's curative effect was compared with the analysis of NIHSS within 24 hours in the later period of treatment. Results Compared with before treatment, NIHSS scores of mechanical thrombectomy group and bridging treatment group were significantly lower 24 h and 14 d after treatment (P<0.05). NIHSS scores of mechanical thrombectomy group and bridging treatment group were lower than those of intravenous thrombolysis group (P<0.05), while NIHSS scores of mechanical thrombectomy group and bridging treatment group were similar at each time point after treatment, without statistical significance (P>0.05). After 90 days, mRS score of bridging group and mechanical thrombectomy group was significantly lower than that of intravenous thrombolysis group (P<0.05), but there was no significant difference between bridging group and mechanical thrombectomy group (P>0.05). Conclusion Intravenous thrombolysis, mechanical thrombectomy or bridging therapy can improve the neurological function of patients with acute cerebral infarction. Mechanical thrombectomy and bridging therapy can improve the neurological function earlier and have better long-term prognosis.

Key words: acute cerebral infarction, intravenous thrombolysis, mechanical thrombectomy, bridging therapy

中图分类号:

R743.33

郑建新, 张帅杰, 孙伟力. 不同血管再通方法在急性脑梗塞患者中的临床疗效评价[J]. 中华养生保健, 2023, 41(4): 4-7.

ZHENG Jian-xin, ZHANG Shuai-jie, SUN Wei-li. Clinical Evaluation of Different Recanalization Methods in Patients with Acute Cerebral Infarction[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(4): 4-7.

参考文献

[1] 毛锐,彭丹丹,张丹,等.机械取栓前进行静脉溶栓预处理治疗动脉粥样硬化性脑梗死的疗效观察[J].脑与神经疾病杂志,2020, 28(11):711-715.
[2] 文永晟. 动静脉联合溶栓与机械取栓治疗急性脑梗死临床疗效的比较研究[J].临床合理用药杂志,2020,13(9):56-58.
[3] 李祥欣. 血管内机械取栓联合动静脉溶栓治疗急性脑梗死疗效观察[J].中国医学工程,2019,27(10):44-47.
[4] 秦抗洪. 机械取栓对重度脑梗死患者疗效分析及治疗进展[J].临床放射学杂志,2020,39(7):1463.
[5] 潘杨军,阳建国,郑银元,等.机械取栓和静脉溶栓治疗急性椎基底动脉闭塞性脑梗死的效果比较[J].中华神经医学杂志,2020,19(7):677-682.
[6] 齐智慧,李东晓.不同静脉溶栓时间窗对进展性脑梗死血管再通及预后的影响[J].临床医学,2019,39(4):28-29.
[7] 顾亮亮,张保朝,付国惠.rt-PA静脉溶栓治疗不同时间窗椎-基底动脉系统脑梗死的临床疗效观察[J].中风与神经疾病杂志,2016, 33:64-66.
[8] 吕华东,马可,蓝瑞芳.经以机械取栓为主的动脉内多模式的大动脉闭塞性脑梗死患者短期预后的影响因素研究[J].实用心脑肺血管病杂志,2018,26(1):38-42.
[9] 张明书,常明则,孟林.机械取栓联合rt-PA溶栓治疗急性脑梗死的血管再通率、神经损伤程度的评估[J].海南医学院学报,2019,25(12): 913-917.
[10] 李菊琴,代青湘,韩吉祥,等.丹红注射液联合曲克芦丁治疗急性脑梗死的疗效及对hs-CRP、TNF-α和IL-6影[J].中华中医药学刊,2019,37(8):2013-2016.
[11] 王鹏,杨占辉,滑丽美.机械取栓联合尿激酶溶栓治疗急性脑梗死的临床效果及其对神经功能、神经保护因子的影[J].临床误诊误治,2019,32(12):94-98.
[12] 赵伟. 重组组织型纤溶酶原激活剂静脉溶栓桥接机械取栓治疗急性脑梗死效果分析[J].中国实用医刊,2019(7):80-82.
[13] SAVER J L, GOYAL M, BONAFE A, et al.Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke[J]. The New England journal of medicine,2015,372(24):2285-2295.
[14] BEHME D, KABBASCH C, KOWOLL A, et al.Intravenous Thrombolysis Facilitates Successful Recanalization with Stent-Retriever Mechanical Thrombectomy in Middle Cerebral Artery Occlusions[J]. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2016,25(4):954-959.
[15] GUEDIN P, LARCHER A, DECROIX J P, et al.Prior IV Thrombolysis Facilitates Mechanical Thrombectomy in Acute Ischemic Stroke[J]. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association,2015,24(5):952-957.
[16] BOURCIER R, ALEXANDRE P L, EUGÈNE F, et al. Is bridging therapy still required in stroke due to carotid artery terminus occlusions?[J].Journal of neurointerventional surgery,2018,10(7):625-628.
[17] WEBER R, NORDMEYER H, HADISURYA J, et al.Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis[J].Journal of neurointerventional surgery,2017,9(3):229-233.