摘要
目的:比较直接机械血栓切除(mechanical thrombectomy, MT)与静脉溶栓(intravenous thrombolysis, IVT)桥接MT(IVT+MT)治疗高血栓负荷急性前循环大血管闭塞性卒中患者的临床效果。方法:回顾性连续纳入2015年6月至2019年4月在柳州市人民医院神经内科收治的血栓负荷评分≤6分并接受血管内治疗(MT或IVT+MT)的急性前循环大血管闭塞性卒中患者。对直接MT组与IVT+MT组的基线临床资料、手术情况、临床转归、住院天数以及住院费用进行比较。在卒中发病后90 d采用改良Rankin量表进行转归评价,0-2分定义为转归良好,>2分定义为转归不良。采用多变量 logistic回归分析确定转归不良的独立影响因素。 结果:共纳入高血栓负荷的急性前循环大血管闭塞性卒中患者115例,年龄(65.4±12.0)岁,男性70例(60.9%);基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分18.0(14.0-22.0)分;直接MT组70例(60.9%),IVT+MT组45例(39.1%);49例(42.6%)转归良好,66例(57.4%)转归不良。直接MT组发病至腹股沟穿刺时间[210(130-255)min对230(187-268)min;Z=-1.982, P=0.047]和发病至血管成功再通时间[283(228-358)min对320(268-385)min;Z=-2.017, P=0.044]显著短于IVT+MT组,但血管成功再通率(84.4%对81.4%;χ^2=0.173, P=0.677)、术后有症状颅内出血发生率(6.7%对7.1%;P=1.000)以及90 d转归良好率(40.0%对44.3%;χ^2=0.206, P=0.650)与IVT+MT组均差异无统计学意义。此外,尽管两组住院时间差异无统计学意义[(12.1±7.1)d对(10.6±6.6)d;t=1.128, P=0.262],但直接MT组住院总费用显著低于IVT+MT组[80 328(63 214-101 136)CNY对88 517(68 001-115 590)CNY;Z=-1.972, P=0.049]。多变量 logistic回归分析表明,基线收缩压较高[优势比(odds ratio, OR)1.033,95%可信区间(confidence interval, CI)1.005-1.062;P=0.019]、基线NIHSS评分较高( OR 1.117,95% CI 1.029-1.213;P=0.008)和基线阿尔伯塔卒中项目早期CT评分较低( OR 0.189,95% CI 0.056-0.641;P=
Objective To compare the clinical effects of direct mechanical thrombectomy(MT)and intravenous thrombolysis(IVT)bridging MT(IVT+MT)in the treatment of patients with acute anterior circulation large vessel occlusive stroke with high clot burden.Methods Consecutive patients with acute anterior circulation large vessel occlusion with clot burden score≤6 admitted to the Department of Neurology,Liuzhou People's Hospital and received endovascular treatment(MT or IVT+MT)from June 2015 to April 2019 were enrolled retrospectively.The baseline clinical data,surgical status,clinical outcome,length of stay and cost of hospitalization in the direct MT group and the IVT+MT group were compared.The modified Rankin Scale was used to evaluate the outcomes at 90 d after the onset of stroke.0-2 was defined as a good outcome and>2 was defined as a poor outcome.Multivariate logistic regression analysis was used to identify the independent influencing factors of poor outcomes.Results A total of 115 patients with acute anterior circulation large vascular occlusive stroke with high clot burden were enrolled,aged 65.4±12.0 years,70(60.9%)were male.The baseline National Institutes of Health Stroke Scale(NIHSS)score was 18.0(14.0-22.0).Seventy patients(60.9%)in the direct MT group,45 in the IVT+MT group(39.1%).Forty-nine patients(42.6%)had a good outcome and 66(57.4%)had a poor outcome.The time from onset to inguinal puncture(210[130-255]min vs.230[187-268]min;Z=-1.982,P=0.047)and the time from onset to successful vascular recanalization(283[228-358]min vs.320[268-385]min;Z=-2.017,P=0.044)were significantly shorter than the IVT+MT group,but there were no significant differences in the successful recanalization rate(84.4%vs.81.4%;χ^2=0.173,P=0.677),the incidence of postoperative symptomatic intracranial hemorrhage(6.7%vs.7.1%;P=1.000)and the good outcome rate at 90 d(40.0%vs.44.3%;χ^2=0.206,P=0.650)between the direct MT group and the IVT+MT group.In addition,although there was no significant difference in length of stay between the two
作者
覃惠洵
高文
张皆德
邬剑雄
覃彬
陈红
Qin huixun;Gao Wen;Zhang Jiede;Wu Jianxiong;Qin Bin;Chen Hong(Department of Neurology,Liuzhou People's Hospital,Liuzhou 545006,China)
出处
《国际脑血管病杂志》
2020年第8期567-573,共7页
International Journal of Cerebrovascular Diseases
基金
柳州市科技计划项目(2018AF10502)。
关键词
卒中
脑缺血
颅内血栓形成
血栓切除术
血管内手术
血栓溶解疗法
治疗结果
Stroke
Brain ischemia
Intracranial thrombosis
Thrombectomy
Endovascular procedures
Thrombolytic therapy
Treatment outcome
