[1]谭文刚.血管内机械取栓治疗急性脑梗死疗效观察[J].新乡医学院学报,2019,36(1):085-88.[doi:10.7683/xxyxyxb.2019.01.019]
　TAN Wen-gang.Clinical efficacy of intravascular mechanical thrombectomy in the treatment of acute ischemic stroke[J].Journal of Xinxiang Medical University,2019,36(1):085-88.[doi:10.7683/xxyxyxb.2019.01.019]
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血管内机械取栓治疗急性脑梗死疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年1
页码:
085-88
栏目:
临床研究
出版日期:
2019-01-05

文章信息/Info

Title:
Clinical efficacy of intravascular mechanical thrombectomy in the treatment of acute ischemic stroke
作者:
谭文刚
（驻马店市中心医院神经内三科，河南　驻马店　463000）
Author(s):
TAN Wen-gang
（Department of NO.3 Neurology，the Central Hospital of Zhumadian City，Zhumadian 463000，Henan Province，China）
关键词:
机械取栓; 急性脑梗死; 临床疗效; 安全性
Keywords:
mechanical thrombectomy; acute ischemic stroke; clinical efficacy; safety
分类号:
R743.32
DOI:
10.7683/xxyxyxb.2019.01.019
文献标志码:
A
摘要:
目的　探讨机械取栓治疗急性脑梗死的临床疗效及安全性。方法　选择驻马店市中心医院2014年3月至2017年3月收治的166例急性脑梗死患者为研究对象，根据治疗方法分为动脉溶栓组（n=86）和机械取栓组（n=80）。采用美国国家研究院卒中量表（NIHSS）评分评定2组患者治疗前及治疗后24 h和7、30、90 d的神经功能恢复情况，采用改良Rankin量表（mRS）评分评定2组患者治疗前及治疗后90 d的神经功能状态，观察2组患者术中血管复通情况、临床疗效及不良反应。结果　2组患者治疗前及治疗后24 h NIHSS评分比较差异无统计学意义（P>0.05），机械取栓组患者治疗后7、30、90 d NIHSS评分显著低于动脉溶栓组（P<0.05）。2组患者治疗前mRS评分比较差异无统计学意义（t=0.368，P>0.05）；治疗后90 d，机械取栓组患者mRS评分显著低于动脉溶栓组（t=2.572，P<0.05）。动脉溶栓组和机械取栓组患者血管总复通率分别为65.1%（56/86）和87.6%（70/80），机械取栓组患者血管总复通率高于动脉溶栓组（χ2=11.351，P<0.01）。动脉溶栓组和机械取栓组患者治疗总有效率分别为60.5%（52/86）和87.6%（70/80），机械取栓组患者治疗总有效率高于动脉溶栓组（χ2=15.550，P<0.01）。动脉溶栓组和机械取栓组患者不良反应发生率分别为67.4（58/86）和17.5（14/80），机械取栓组患者不良反应发生率低于动脉溶栓组（χ2=42.092，P<0.01）。结论　机械取栓治疗急性脑梗死较动脉溶栓治疗能够显著提高闭塞血管的复通率，改善患者的神经功能及生理功能，提高临床疗效，且不良反应少，治疗安全性较好。
Abstract:
Objective　To explore the clinical efficacy and safety of intravascular mechanical thrombectomy in the treatment of acute ischemic stroke.Methods　One hundred and sixty-six patients with acute ischemic stroke treated in the Central Hospital of Zhumadian City from March 2014 to March 2017 were divided into arterial thrombolysis group（n=86） and mechanical thrombectomy group （n=80） according to the different treatment methods.The neurological function of the two groups of patients was evaluated by national institutes of health stroke scale(NIHSS) before treatment and 24 h，7，30 and 90 days after treatment，and the neurological functional state was evaluated by modified Rankin scale(mRS) before treatment and 90 days after treatment.The intraoperative vascular recanalization，clinical efficacy and adverse reactions of the two groups were observed.Results　There was no significant difference in NIHSS score between the two groups before and 24 h after treatment （P>0.05）.The NIHSS scores of patients in the mechanical thrombectomy group at 7，30 and 90 days after treatment were significantly lower than those in the arterial thrombolysis group （P<0.05）.There was no statistically significant difference in mRS score between the two groups before treatment （t=0.368，P>0.05）.The mRS score of the mechanical thrombolysis group was significantly lower than that of the arterial thrombolysis group at 90 days after treatment （t=2.572，P<0.05）.The total vascular recanalization rate of the arterial thrombolysis group and mechanical thrombolysis group was 65.1% （56/86） and 87.6% （70/80），respectively.The total vascular recanalization rate in the mechanical thrombolysis group was higher than that in the arterial thrombolysis group （χ2=11.351，P<0.01）.The total effective rate of arterial thrombolysis group and mechanical thrombolysis group was 60.5% （52/86） and 87.6% （70/80），respectively.The total therapeutic efficacy of mechanical thrombolysis group was higher than that of arterial thrombolysis group （χ2=15.550，P<0.01）.The incidence of adverse reactions in patients in the arterial thrombolysis group and mechanical thrombolysis group was 67.4% （58/86） and 17.5% （14/80），respectively.The incidence of adverse reactions in the mechanical thrombolysis group was lower than that in the arterial thrombolysis group，and the difference was statistically significant （χ2=42.092，P<0.01）.Conclusion　Compared with arterial thrombolytic therapy，mechanical thrombolytic therapy for acute ischemic stroke can significantly improve the recanalization rate of occluded blood vessels，improve the nerve function and physiological function of patients，thereby improving the clinical efficacy，with fewer adverse reactions，and better treatment safety.

参考文献/References:

［1］　徐辉，王经忠，张莹，等.重度大脑中动脉狭窄所致内分水岭梗死患者早期脑卒中进展的相关危险因素分析［J］.中华老年心脑血管病杂志，2017，19（4）：399-402.
［2］　谷雨冰，周彤.缺血性脑卒中治疗指导及预后评价指标研究新进展［J］.中国医刊，2016，51（1）：36-39.
［3］　孙玉芳，张芹，李继梅，等.静脉溶栓治疗急性缺血性脑卒中的研究进展［J］.中国全科医学，2015，18（12）：1371-1375.
［4］　FORLIVESI S，BOVI P，CAPPELLARI M.Mechanical thrombectomy for acute ischemic stroke in a patient with concomitant spontaneous intracerebral hemorrhage［J］.J Stroke Cerebrovasc Dis，2017，26（8）：e150-e152.
［5］　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2014［J］.中华神经科杂志，2015，48（4）：246-257.
［6］　KIM W J，NAH H W，KIM D H，et al.Association between left ventricular dysfunction and functional outcomes at three months in acute ischemic stroke［J］.J Stroke Cerebrovasc Dis，2016，25（9）：2247-2252.
［7］　范玉华，姬晓昙，蓝琳芳，等.国内脑卒中临床试验疗效判断方法中改良Rankin评分的应用现状［J］.中国神经精神疾病杂志，2015，47（7）：412-415.
［8］　KRAJCˇKOV D，KRAJINA A，HERZIG R，et al.Mechanical recanalization in ischemic anterior circulation stroke within an 8-hour time window：a real-world experience［J］.Diagn Interv Radiol，2017，23（6）：465-471.
［9］　ZUPANIC E，VON EULER M，KREHOLT I，et al.Thrombolysis in acute ischemic stroke in patients with dementia：a Swedish registry study［J］.Neurology，2017，89（18）：1860-1868.
［10］　CASSELLA C R，JAGODA A.Ischemic stroke：advances in diagnosis and management［J］.Emerg Med Clin North Am，2017，35（4）：911-930.
［11］　TAWIL S E，MUIR K W.Thrombolysis and thrombectomy for acute ischaemic stroke［J］.Clin Med （Lond），2017，17（2）：161-165.
［12］　LI Y，XIA Y，CHEN H，et al.Focal low and global high permeability predict the possibility，risk，and location of hemorrhagic transformation following intra-arterial thrombolysis therapy in acute stroke［J］.AJNR Am J Neuroradiol，2017，38（9）：1730-1736.
［13］　SRINIVASAN V M，CHEN S R，CAMSTRA K M，et al.Development of a recalcitrant，large clot burden，bifurcation occlusion model for mechanical thrombectomy［J］.Neurosurg Focus，2017，42（4）：E6.
［14］　PIEROT L，GAWLITZA M，SOIZE S.Techniques for endovascular treatment of acute ischemic stroke［J］.Rev Neurol，2017，173（9）：594-599.
［15］　CHANG J Y，PARK H，JANG S Y，et al.Early partial recanalization after intravenous thrombolysis leads to prediction of favorable outcome in cases of acute ischemic stroke with major vessel occlusion［J］.J Clin Neurosci，2017，46（1）：30-36.
［16］　KROGIAS C，BARTIG D，KITZROW M，et al.Availability of mechanical thrombectomy for acute stroke：analysis of the health care reality in Germany［J］.Nervenarzt，2017，88（10）：1177-1185.

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更新日期/Last Update: 2019-01-05