中国神经精神疾病杂志
中國神經精神疾病雜誌
중국신경정신질병잡지
CHINESE JOURNAL OF NERVOUS AND MENTAL DISEASES
2015年
7期
406-411
,共6页
马朝晖%李贵福%尤劲松%朱吉祥%罗望池%张迎光%郭建文%陈发军%石尧%薛道金%张佛明%龙龙%朱文燕%古振云%黄燕%李铁林
馬朝暉%李貴福%尤勁鬆%硃吉祥%囉望池%張迎光%郭建文%陳髮軍%石堯%薛道金%張彿明%龍龍%硃文燕%古振雲%黃燕%李鐵林
마조휘%리귀복%우경송%주길상%라망지%장영광%곽건문%진발군%석요%설도금%장불명%룡룡%주문연%고진운%황연%리철림
缺血性卒中%溶栓%机械取栓%脑动脉闭塞
缺血性卒中%溶栓%機械取栓%腦動脈閉塞
결혈성졸중%용전%궤계취전%뇌동맥폐새
Acute ischemic stroke%Intra-arterial%Thrombolysis Large intracranial vessel occlusion%Thrombectomy
目的：对比分析机械取栓与动脉溶栓血管再通方法对于治疗急性脑动脉闭塞的有效性及安全性。方法回顾比较分析2005年5月至2014年5月期间行动脉溶栓及机械取栓患者，比较其发病到入院时间、入院到穿刺时间以及穿刺到获得再通时间、血管再通率TICI评分、患者术前及出院时NIHSS评分变化、90d时MRS评分、颅内出血发生率、死亡率。结果机械取栓组102例，动脉溶栓组50例，两组在发病入院时间(300 min vs.120 min，Z=-5.704，P=0.000)，穿刺到再通时间(30 min vs.65 min，Z=-5.011，P=0.001)存在统计学差异，机械取栓组明显优于动脉溶栓组。两组在血管再通率(91.2%vs.60.0%，P=0.01)、总出血率(21.7%vs.36.0%，P=0.046)、死亡率(16.6%vs.26.0%，P=0.043)比较存在统计学差异，机械取栓组明显优于动脉溶栓组。两组90d时症状性出血率(12%vs.16%，P=0.055)、NIHSS评分变化(3 vs.4，Z=-0.236，P=0.823)、90d时良好预后率(48.2%vs.46.0%, P=0.823)比较无统计学差异。机械取栓组的支架放置率高于动脉溶栓组(22.5%vs.8.0%，P=0.018)。两组责任血管分层比较：机械取栓组颈内动脉（81.8%vs.55.6%，P=0.048）、基底动脉（93.1%vs.55.6%，P=0.032）、大脑中动脉（97.5%vs.60%,P=0.026）的血管再通率明显高于动脉溶栓组，机械取栓组颈内动脉(13.8%vs.33.3%，P=0.001)、基底动脉(13.8%vs.22.2%，P=0.011)的症状性出血率明显低于动脉溶栓组。机械取栓组大脑中动脉死亡率显著低于动脉溶栓组(2.5%vs.20.0%，P=0.000)。机械取栓组基底动脉良好预后率明显高于动脉溶栓组（41.3%vs.22.2%，P﹤0.01）。结论对于急性脑动脉闭塞患者的血管内治疗，机械取栓相比动脉溶栓有更宽的时间窗，更高的再通率和更好的预后。
目的：對比分析機械取栓與動脈溶栓血管再通方法對于治療急性腦動脈閉塞的有效性及安全性。方法迴顧比較分析2005年5月至2014年5月期間行動脈溶栓及機械取栓患者，比較其髮病到入院時間、入院到穿刺時間以及穿刺到穫得再通時間、血管再通率TICI評分、患者術前及齣院時NIHSS評分變化、90d時MRS評分、顱內齣血髮生率、死亡率。結果機械取栓組102例，動脈溶栓組50例，兩組在髮病入院時間(300 min vs.120 min，Z=-5.704，P=0.000)，穿刺到再通時間(30 min vs.65 min，Z=-5.011，P=0.001)存在統計學差異，機械取栓組明顯優于動脈溶栓組。兩組在血管再通率(91.2%vs.60.0%，P=0.01)、總齣血率(21.7%vs.36.0%，P=0.046)、死亡率(16.6%vs.26.0%，P=0.043)比較存在統計學差異，機械取栓組明顯優于動脈溶栓組。兩組90d時癥狀性齣血率(12%vs.16%，P=0.055)、NIHSS評分變化(3 vs.4，Z=-0.236，P=0.823)、90d時良好預後率(48.2%vs.46.0%, P=0.823)比較無統計學差異。機械取栓組的支架放置率高于動脈溶栓組(22.5%vs.8.0%，P=0.018)。兩組責任血管分層比較：機械取栓組頸內動脈（81.8%vs.55.6%，P=0.048）、基底動脈（93.1%vs.55.6%，P=0.032）、大腦中動脈（97.5%vs.60%,P=0.026）的血管再通率明顯高于動脈溶栓組，機械取栓組頸內動脈(13.8%vs.33.3%，P=0.001)、基底動脈(13.8%vs.22.2%，P=0.011)的癥狀性齣血率明顯低于動脈溶栓組。機械取栓組大腦中動脈死亡率顯著低于動脈溶栓組(2.5%vs.20.0%，P=0.000)。機械取栓組基底動脈良好預後率明顯高于動脈溶栓組（41.3%vs.22.2%，P﹤0.01）。結論對于急性腦動脈閉塞患者的血管內治療，機械取栓相比動脈溶栓有更寬的時間窗，更高的再通率和更好的預後。
목적：대비분석궤계취전여동맥용전혈관재통방법대우치료급성뇌동맥폐새적유효성급안전성。방법회고비교분석2005년5월지2014년5월기간행동맥용전급궤계취전환자，비교기발병도입원시간、입원도천자시간이급천자도획득재통시간、혈관재통솔TICI평분、환자술전급출원시NIHSS평분변화、90d시MRS평분、로내출혈발생솔、사망솔。결과궤계취전조102례，동맥용전조50례，량조재발병입원시간(300 min vs.120 min，Z=-5.704，P=0.000)，천자도재통시간(30 min vs.65 min，Z=-5.011，P=0.001)존재통계학차이，궤계취전조명현우우동맥용전조。량조재혈관재통솔(91.2%vs.60.0%，P=0.01)、총출혈솔(21.7%vs.36.0%，P=0.046)、사망솔(16.6%vs.26.0%，P=0.043)비교존재통계학차이，궤계취전조명현우우동맥용전조。량조90d시증상성출혈솔(12%vs.16%，P=0.055)、NIHSS평분변화(3 vs.4，Z=-0.236，P=0.823)、90d시량호예후솔(48.2%vs.46.0%, P=0.823)비교무통계학차이。궤계취전조적지가방치솔고우동맥용전조(22.5%vs.8.0%，P=0.018)。량조책임혈관분층비교：궤계취전조경내동맥（81.8%vs.55.6%，P=0.048）、기저동맥（93.1%vs.55.6%，P=0.032）、대뇌중동맥（97.5%vs.60%,P=0.026）적혈관재통솔명현고우동맥용전조，궤계취전조경내동맥(13.8%vs.33.3%，P=0.001)、기저동맥(13.8%vs.22.2%，P=0.011)적증상성출혈솔명현저우동맥용전조。궤계취전조대뇌중동맥사망솔현저저우동맥용전조(2.5%vs.20.0%，P=0.000)。궤계취전조기저동맥량호예후솔명현고우동맥용전조（41.3%vs.22.2%，P﹤0.01）。결론대우급성뇌동맥폐새환자적혈관내치료，궤계취전상비동맥용전유경관적시간창，경고적재통솔화경호적예후。
Objective To investigate the safety and efficacy of mechanical thrombectomy (MT) compared with In?tra-arterial Thrombolysis (IAT) treatment in patients with severe acute ischemic stroke (AIS) caused by large cerebral ar?tery occlusion. Method The patients with AIS caused by large cerebral artery occlusion and underwent MT or IAT from 2005 May to 2014 May was included. A retrospective analysis was conducted on the onset to emergency(OTE)time, emergency to acupuncture(ETA)time, acupuncture to recanalization (ATR) time, stroke severity as measured by the Na?tional Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on magnetic resonance angiography (MRA). A comparison was made between MT and IAT patients in rates of recanalization, symptomatic intracranial bleed?ing (SIB), mortality, and functional outcome. Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score≤2. Result One hundred and two AIS patients were treated with MT and 50 with IAT. There was no differ?ence between MT and IAT groups with regard to demographics, onset NIHSS score (13.37±6.95 vs. 12.70±6.11;P=0.572) and discharge NIHSS score (8.40 ± 6.69 vs. 7.53 ± 7.28, P= 0.522) and the change of NIHSS score (3.87 ± 7.14 vs. 4.26 ± 5.42, P=0.766). There were significantly differences between MT and IAT groups in the OTE time (Median 300 min vs. 120 min,Z=-5.704,P=0.000) , ATR time (Median 30 min vs. 65 min,Z=-5.011,P=0.001) ,recanalization (91.2%vs. 60.0%,P =0.01),the rate of AIB(21.7% vs. 36.0%,P =0.046),3-month mortality (16.6% vs. 26.0%,P =0.043). The above parameters were better in MT group than in the IAT group. There were no significant differences between MT and IAT groups in the rate of SIB (12% vs. 16%,P =0.055), the NIHSS change(Median 3 vs. 4,Z =-0.236,P =0.823) and mRS score on 90d ( 48.2%vs. 46.0%, P=0.823). MT patients had significantly higher percentages of stent use (22.5%vs. 8%,P=0.018) . The Recanalization for ICA(81.8%vs. 55.6%,P=0.048),BA(93.1%vs. 55.6%,P=0.032)and MCA( 97.5% vs. 60.0%,P =0.026)was higher in MT group than in IAT group .The SIB rate for ICA(13.8% vs. 33.3%,P =0.000),BA(13.8%vs. 33.3%,P=0.000)was lower in MT group than in IAT group . The mortality rate of was significant?ly lower in MT than in IAT group for MCA (2.5%vs. 20.0%,P=0.000) . the good outcome rate for BA was higher in MT group than in IAT group(41.3%vs. 22.2%,P﹤0.01). Conclusions Compared to IAT,MT can provide broader time win?dow,higher recanalization rate and better outcome in patients with severe acute ischemic stroke (AIS) caused by large ce?rebral artery occlusion.
