作者：罗政云，陈轲，付航

单位：

551400贵州省清镇市第一人民医院神经外科 通信作者：付航，E-mail：361585946@qq.com

Units：

Department of Neurosurgery, Qingzhen First People's Hospital, Qingzhen 551400, China Corresponding author: FU Hang, E-mail: 361585946@qq.com

关键词：

卒中; 导管抽吸取栓; 支架取栓; 神经功能; 远期预后;

Keywords：

Stroke; Catheter suction embolus; Stent thrombectomy; Neurological function; Long-term prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.014

Funds：

贵阳市卫生健康局科学技术计划项目（［2020］筑卫健科技合同字第027号）

摘要：

背景脑卒中具有致死风险高、神经功能损伤严重的特点,支架取栓、导管抽吸取栓治疗均是快速消除患者血栓、降低病死率以及改善患者神经功能与预后的重要治疗方案,明确支架取栓、导管抽吸取栓治疗脑卒中患者的临床效果对提高临床疗效以及改善患者神经功能具有重要意义。目的比较导管抽吸取栓与支架取栓治疗急性缺血性脑卒中的疗效。方法采用随机抽样法选取清镇市第一人民医院2018年9月—2021年5月收治的急性缺血性脑卒中住院患者80例,采用随机数字表法将患者分为常规组、研究组,每组40例。常规组采用支架取栓治疗,研究组采用导管抽吸取栓治疗。比较两组患者血管再通率及血管再通时间,术前及术后24 h、7 d、30 d、90 d美国国立卫生研究院卒中量表(NIHSS)评分,术前及术后90 d改良Rankin量表(mRS)评分,术后并发症发生率及术后90 d存活率。结果两组患者血管再通率比较,差异无统计学意义(P> 0.05);研究组患者血管再通时间短于常规组(P <0.05)。治疗方法与时间在NIHSS评分上存在交互作用(P <0.05);时间、治疗方法在NIHSS评分上主效应均显著(P <0.05)。术后30、90 d研究组患者NIHSS评分低于常规组(P <0.05);两组患者术后30、90 d NIHSS评分分别低于本组术前,术后90 d NIHSS评分分别低于本组术后30 d(P <0.05)。术后90 d两组患者mRS评分分别低于本组术前,且研究组患者mRS评分低于常规组(P <0.05)。研究组并发症总发生率为5.0%(2/40),低于常规组的22.5%(9/40)(P <0.05)。术后90 d研究组患者存活率为90.0%(36/40),与常规组的85.0%(34/40)比较,差异无统计学意义(P> 0.05)。结论导管抽吸取栓治疗与支架取栓治疗在急性缺血性脑卒中患者中均具有良好的血管再通效果,而导管抽吸取栓治疗可明显缩短患者血管再通时间,改善患者神经功能及日常生活能力,且有效降低患者症状性血栓逃逸等并发症发生风险。

Abstract：

【Abstract】　Background Stroke patients have the characteristics of high risk of death and serious neurologicalinjury. Stent thrombectomy and catheter suction embolus are both important treatment options for rapidly eliminating thrombosis,reducing mortality and improving neurological function and prognosis of patients. It is of great significance to clarify the clinicaleffect of stent thrombectomy and catheter suction embolus in the treatment of stroke patients to improve the clinical efficacy andneurological function of patients. Objective To compare the efficacy of catheter suction embolus and stent thrombectomy inthe treatment of stroke. Methods A random sampling method was used to select 80 acute ischemic stroke inpatients admittedto Qingzhen First People's Hospital from September 2018 to May 2021. Patients were divided into routine group and study groupby random number table method, with 40 patients in each group. The routine group was treated with stent thrombectomy, and thestudy group was treated with catheter suction embolus. The vascular recanalization rate and recanalization time, National Institutesof Health Stroke Scale (NIHSS) score before surgery and at 24 h, 7 days, 30 days and 90 days after surgery, modified RankinScale (mRS) score before surgery and 90 days after surgery, the incidence of postoperative complications and 90-day survival ratewere compared between the two groups. Results There was no significant difference in vascular recanalization rate between thetwo groups (P > 0.05) ; the vascular recanalization time of patients in the study group was shorter than that in the routine group(P< 0.05) . There was interaction between treatment method and time on NIHSS score (P < 0.05) . The main effect of time andtreatment method were significant on NIHSS score (P < 0.05) . NIHSS scores of patients in the study group were lower than thosein the routine group at 30 and 90 days after surgery (P< 0.05) . NIHSS scores at 30 and 90 days after surgery of patients in the twogroups were lower than those before surgery (P < 0.05) . NIHSS scores at 90 days after surgery of patients in the two groups werelower than those at 30 days after surgery (P < 0.05) . mRS score at 90 days after surgery in the two groups was lower than that beforesurgery, respectively and mRS score at 90 days after surgery in study group was lower than that in routine group (P < 0.05) . Theoverall incidence of complications in the study group (5.0%) was lower than that in the routine group (22.5%) (P < 0.05) . Therewas no significant difference in 90-day survival rate between the study group (90.0%) and the routine group (85.0%) (P > 0.05) .Conclusion Both catheter suction embolus and stent thrombectomy have a great efficacy of revascularization, but cathetersuction embolus can shorten the vascular recanalization time of patients with acute ischemic stroke, improve patients' neurologicalfunction and activity of daily living, and reduce the risk of complications.

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