切换至 "中华医学电子期刊资源库"
高级检索
中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2023, Vol. 13 ›› Issue (06) : 352 -357. doi: 10.3877/cma.j.issn.2095-123X.2023.06.006

临床研究

抽吸联合支架取栓对超时间窗后循环缺血性脑卒中患者脑血灌注的影响
李旺俊, 王云霞†()   
  1. 215500　苏州，徐州医科大学附属常熟医院（常熟市第二人民医院）神经内科
  • 收稿日期:2022-12-20 出版日期:2023-12-15
  • 通信作者: 王云霞

Effects of aspiration combine stent for thrombectomy on cerebral blood perfusion in patients with posterior circulation ischemic stroke beyond the time window

Wangjun Li, Yunxia Wang†()   

  1. Department of Neurology, Changshu Hospital Affiliated to Xuzhou Medical University (Changshu Second People's Hospital), Suzhou 215500, China
  • Received:2022-12-20 Published:2023-12-15
  • Corresponding author: Yunxia Wang
  • Supported by:
    Xuzhou Medical University Affiliated Hospital Development Fund Project(XYFM2021050)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李旺俊, 王云霞. 抽吸联合支架取栓对超时间窗后循环缺血性脑卒中患者脑血灌注的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(06): 352-357.

Wangjun Li, Yunxia Wang. Effects of aspiration combine stent for thrombectomy on cerebral blood perfusion in patients with posterior circulation ischemic stroke beyond the time window[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(06): 352-357.

目的

探究抽吸联合支架取栓对超时间窗后循环缺血性脑卒中患者脑血灌注的影响。

方法

选择徐州医科大学附属常熟医院（常熟市第二人民医院）神经内科自2018年6月至2022年6月收治97例超时间窗后循环缺血性脑卒中患者作为研究对象。根据治疗方案将患者分为2组，药物溶栓组（48例）予重组组织型纤溶酶原激活剂药物溶栓治疗，取栓组（49例）予抽吸联合支架取栓治疗。比较2组患者治疗前后脑血灌注情况，血清神经元特异性烯醇化酶（NSE）、内皮型一氧化氮合酶（eNOS）水平，不良反应及预后情况。

结果

2组患者治疗后脑血容量（CBV）、平均通过时间（MTT）、达峰时间（TTP）及脑血流量（CBF）等脑血灌注情况较治疗前显著改善，取栓组患者治疗后CBV、CBF显著高于药物溶栓组，MTT、TTP明显短于药物溶栓组，差异均有统计学意义（P<0.05）。2组患者治疗后血清NSE水平低于治疗前，eNOS水平高于治疗前，且取栓组血清NSE水平低于药物溶栓组，eNOS水平高于药物溶栓组，差异均有统计学意义（P<0.05）。取栓组患者的不良反应发生率（16.33%）低于药物溶栓组（35.42%），预后良好率（89.90%）高于药物溶栓组（72.92%），差异均有统计学意义（P<0.05）。

结论

抽吸联合支架取栓有助于改善超时间窗后循环缺血性脑卒中患者脑血灌注，治疗疗效及安全性优异。

关键词: 抽吸联合支架取栓, 超时间窗, 后循环缺血性脑卒中, 脑血灌注
Objective

To investigate the effects of aspiration combine stent for thrombolectomy on cerebral blood perfusion in patients with posterior circulation ischemic stroke beyond the time window.

Methods

A total of 97 patients with posterior circulation ischemic stroke beyond the time window who were admitted to Neurology Department of Changshu Hospital Affiliated to Xuzhou Medical University from June 2018 to June 2022 were selected as the study subjects. They were divided into drug thrombolysis group (n=48, thrombolysis with recombinant tissue plasminogen activator) and thrombectomy group (n=49, aspiration combine stent for thrombectomy) based on treatment plan. Cerebral blood perfusion, serum neuron-specific enolase (NSE) and endothelial nitric oxide synthase (eNOS) levels, adverse reactions, and prognosis were compared between two groups before and after treatment.

Results

After treatment, the cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and cerebral blood flow (CBF) of two groups significantly improved compared to before treatment, the CBV and CBF of the thrombectomy group were significantly higher than those of the drug thrombolysis group, while the MTT and TTP were significantly shorter than those of the drug thrombolysis group, and the differences were statistically significant (P<0.05). After treatment, the serum NSE level was lower than before treatment, and the eNOS level was higher than before treatment in two groups of patients, the serum NSE level in the thrombectomy group was lower than that in the drug thrombolysis group, and the eNOS level was higher than that in the drug thrombolysis group, with statistical significance (P<0.05). The incidence of adverse reactions in the thrombectomy group (16.33%) was lower than that in the drug thrombolysis group (35.42%), and the good prognosis rate (89.90%) was higher than that in the drug thrombolysis group (72.92%), with statistical significance (P<0.05).

Conclusion

Aspiration combine stent for thrombectomy is beneficial to improve cerebral blood perfusion in patients with posterior circulation ischemic stroke beyond the time window, with significant curative effect and good safety.

Key words: Aspiration combine stent for thrombectomy, Beyond the time window, Posterior circulation ischemic stroke, Cerebral blood perfusion
表1 2组患者一般资料比较
Tab.1 Comparison of general information between two groups
组别 例数 年龄（岁，Mean±SD） 性别（男/女） 病程（h，Mean±SD） 体质量指数（kg/m2，Mean±SD） 基础疾病（高血压/高脂血症/房颤/糖尿病）
药物溶栓组 48 65.64±6.27 29/19 12.11±1.76 24.85±5.11 20/11/8/9
取栓组 49 63.51±6.71 31/18 12.35±1.84 24.92±5.34 22/9/10/8
t/χ2值   1.615 0.083 1.475 0.066 0.566
P值   0.110 0.773 0.144 0.948 0.904
表2 2组患者治疗前后脑血灌注水平比较（Mean±SD）
Tab.2 Comparison of cerebral blood perfusion levels between two groups before and after treatment (Mean±SD)
组别 例数 时间 MTT（s） CBV（mL/100 mg） TTP（s） CBF[mL/（100 g·min）]
药物溶栓组 48 治疗前 16.52±4.11 65.24±9.36 33.84±7.15 32.84±6.75
治疗后 12.25±3.09 84.62±11.45 24.21±7.08 49.52±5.26
t值 8.218 12.904 9.377 19.244
P值 <0.001 <0.001 <0.001 <0.001
取栓组 49 治疗前 16.85±4.38 67.35±9.48 32.05±7.29 32.61±6.84
治疗后 8.65±3.37a 91.25±12.74a 18.42±6.49a 54.11±5.59a
t值 14.813 15.059 13.848 24.216
P值 <0.001 <0.001 <0.001 <0.001
表3 2组患者治疗前后血清NSE和eNOS水平比较（Mean±SD）
Tab.3 Comparison of serum NSE and eNOS levels between two groups before and after treatment (Mean±SD)
组别 例数 时间 NSE（μg/L） eNOS（U/mL）
药物溶栓组 48 治疗前 29.66±3.15 3.18±0.62
治疗后 22.38±3.28 7.54±0.85
t值 15.688 41.098
P值 <0.001 <0.001
取栓组 49 治疗前 29.15±3.27 3.25±0.67
治疗后 17.62±3.49a 10.74±0.96a
t值 23.634 63.671
P值 <0.001 <0.001
表4 2组患者不良反应发生率比较[例（%）]
Tab.4 Comparison of adverse reaction rates between two groups [n(%)]
组别 例数 颅内出血 尿路出血 血管再闭 再灌注损伤 总计
药物溶栓组 48 6（12.50） 2（4.17） 5（10.42） 4（8.33） 17（35.42）
取栓组 49 2（4.08） 1（2.04） 3（6.12） 2（4.08） 8（16.33）
χ2值           4.619
P值           0.032
表5 2组患者预后情况比较[例（%）]
Tab.5 Comparison of prognosis between two groups [n(%)]
组别 例数 mRs 0级 mRs 1级 mRs 2级 mRs 3级 mRs 4级 mRs 5级 预后良好
药物溶栓组 48 7（14.58） 12（25.00） 16（33.33） 12（25.00） 1（2.08） 0 35（72.92）
取栓组 49 6（12.24） 18（36.73） 20（40.82） 5（10.20） 0 0 44（89.90）
Z/χ2值   1.769 4.571
P值   0.184 0.033
[1]
Kazi SA, Siddiqui M, Majid S. Stroke outcome prediction using admission nihss in anterior and posterior circulation stroke[J]. J Ayub Med Coll Abbottabad, 2021, 33(2): 274-278.
[2]
Weyland CS, Neuberger U, Potreck A, et al. Reasons for failed mechanical thrombectomy in posterior circulation ischemic stroke patients[J]. Clin Neuroradiol, 2021, 31(3): 745-752. DOI: 10.1007/s00062-020-00950-x.
[3]
彭兆龙,石军峰,刘斌,等.急性缺血性脑卒中MSU与常规救治疗效的对比分析[J].中华神经创伤外科电子杂志, 2021, 7(5): 277-280. DOI: 10.3877/cma.j.issn.2095-9141.2021.05.005.
[4]
钟根龙,项琳,陈伟康,等.不同时间窗溶栓治疗急性缺血性卒中患者CT灌注成像核心梗死的可逆性研究[J].中华神经科杂志, 2020, 53(1): 31-37. DOI: 10.3760/cma.j.issn.1006-7876.2020.01.007.
[5]
Jadhav AP, Desai SM, Budzik RF, et al. First pass effect in patients with large vessel occlusion strokes undergoing neurothrombectomy: insights from the Trevo retriever registry[J]. J Neurointerv Surg, 2021, 13(7): 619-622. DOI: 10.1136/neurintsurg-2020-016952.
[6]
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. DOI: 10.3760/cma.j.issn.1006-7876.2018.09.004.
[7]
Dijkland SA, Voormolen DC, Venema E, et al. Utility-weighted modified rankin scale as primary outcome in stroke trials: a simulation study[J]. Stroke, 2018, 49(4): 965-971. DOI: 10.1161/STROKEAHA.117.020194.
[8]
Baek JW, Heo YJ, Kim ST, et al. Comparison of the solitaire and trevo stents for endovascular treatment of acute ischemic stroke: a single. Center experience[J]. Neurol India, 2021, 69(2): 378-382. DOI: 10.4103/0028-3886.314580.
[9]
Jolugbo P, Ariëns RAS. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke[J]. Stroke, 2021, 52(3): 1131-1142. DOI: 10.1161/STROKEAHA.120.032810.
[10]
张洪宇,夏清,魏露,等.廓清障碍对脑卒中偏瘫足下垂患者平衡及步行功能的影响[J].中华脑科疾病与康复杂志(电子版), 2021, 11(6): 353-357. DOI: 10.3877/cma.j.issn.2095-123X.2021.06.007.
[11]
康梅娟,温昌明,张保朝,等.超时间窗后循环缺血性脑梗死TREVO支架取栓再通有效性及对Vaspin认知功能的影响[J].中国实用神经疾病杂志, 2021, 24(5): 408-413. DOI: 10.12083/SYSJ.2021.05.004.
[12]
Weyland CS, Neuberger U, Potreck A, et al. Reasons for failed mechanical thrombectomy in posterior circulation ischemic stroke patients[J]. Clin Neuroradiol, 2021, 31(3): 745-752. DOI: 10.1007/s00062-020-00950-x.
[13]
段文博,张照龙,崔永强,等.应用Trevo ProVue支架取栓治疗前循环脑动脉急性闭塞的初步经验[J].中国卒中杂志, 2018, 13(8): 780-784. DOI: 10.3969/j.issn.1673-5765.2018.08.004.
[14]
李娜,吉训明.颅内动脉粥样硬化性病变或栓塞对急性缺血性卒中机械取栓患者预后的影响[J].中国脑血管病杂志, 2022, 19(6): 368-375. DOI: 10.3969/j.issn.1672-5921.2022.06.002.
[15]
刘艳峰,吴洁,肖丽萍,等. TREVO支架取栓治疗超时间窗后循环缺血性脑卒中的疗效[J].中国实用神经疾病杂志, 2022, 25(5): 577-582. DOI: 10.12083/SYSJ.220183.
[16]
Khandare P, Saluja A, Solanki RS, et al. Serum S100B and NSE levels correlate with infarct size and bladder-bowel involvement among acute ischemic stroke patients[J]. J Neurosci Rural Pract, 2022, 13(2): 218-225. DOI: 10.1055/s-0042-1743214.
[17]
左书浩,宋春旺,朱习会,等. Trevo支架取栓对缺血性脑卒中患者血清Vaspin、NSE、血液流变学及认知功能的影响[J].疑难病杂志, 2019, 18(10): 986-990. DOI: 10.3969/j.issn.1671-6450.2019.10.004.
[18]
杨鲁杰,邢树礼,司婕,等.小檗碱干预缺血性脑卒中大鼠的作用机制研究[J].中西医结合心脑血管病杂志, 2022, 20(7): 1232-1238. DOI: 10.12102/j.issn.1672-1349.2022.07.013.
[19]
de Havenon A, Castonguay A, Nogueira R, et al. Prestroke disability and outcome after thrombectomy for emergent anterior circulation large vessel occlusion stroke[J]. Neurology, 2021, 97(19): 1914-1919. DOI: 10.1212/WNL.0000000000012827.
No related articles found!
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号