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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
孙若水,左万贵,刘颉.Solitaire AB型支架取栓治疗急性缺血性脑卒中患者的效果[J].中华老年多器官疾病杂志,2018,17(6):442~446
Solitaire AB型支架取栓治疗急性缺血性脑卒中患者的效果
Efficacy of Solitaire AB stent thrombectomy in the treatment of acute ischemic stroke patients
投稿时间:2018-01-29  修订日期:2018-03-01
DOI:10.11915/j.issn.1671-5403.2018.06.099
中文关键词:  急性缺血性脑卒中;取栓术;Solitaire AB型支架;效果
英文关键词:acute ischemic stroke; thrombectomy; Solitaire AB stent; efficacy
基金项目:
作者单位E-mail
孙若水 甘肃省庆阳市人民医院神经外科,庆阳 745000 3112621770@qq.com 
左万贵 甘肃省庆阳市人民医院神经外科,庆阳 745000  
刘颉 甘肃省庆阳市人民医院神经外科,庆阳 745000  
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中文摘要:
      目的 评价Solitaire AB型支架取栓术治疗急性脑动脉闭塞患者的效果。方法 回顾性分析2014年11月至2016年1月甘肃省庆阳市人民医院神经外科诊治的94例急性缺血性脑卒中(AIS)患者,根据治疗方法将患者分为Solitaire AB型支架取栓术组(A组)40例和常规微导管机械碎栓术组(B组)54例,术后随访3个月,比较2组患者手术前后神经功能指标。采用前向血流评定分级(TICI)、美国国立卫生研究院卒中量表(NIHSS)及改良Rankin量表问卷(MRS)评价治疗效果。采用SPSS 16.0统计软件对数据进行分析。根据数据类型,组间比较采用独立样本t检验或χ2检验,组内比较采用配对t检验。结果 2组患者同一时间点血清神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S100β)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6 (IL-6)水平差异均无统计学意义(P>0.05);术后24 h,2组患者NSE、S100β、TNF-α及IL-6水平均较术前显著升高,术后72 h均较术前显著下降,差异有统计学意义(P<0.05)。A组患者TICI Ⅲ级占70.00%(28/40)、TICI Ⅱ级17.50%(7/40),TICI 0~Ⅰ级12.50%(5/40),B组患者TICI Ⅲ级占57.41%(31/54)、TICI Ⅱ级25.93%(14/54),TICI 0~Ⅰ级16.67%(9/54),2组TICI分级比较差异无统计学意义(P=0.238)。2组患者同一时间点NIHSS评分比较差异无统计学意义(P>0.05),但术后1周及术后2周2组患者NIHSS评分均较术前显著降低(P<0.05)。术后3个月,2组患者预后良好率比较差异无统计学意义(80.00% vs 70.37%,P>0.05)。结论 Solitaire AB型支架取栓术治疗AIS患者效果与常规机械碎栓的效果相差不大,但操作相对复杂,难度较高,临床医师需根据患者情况合理选择手术方法。
英文摘要:
      Objective To evaluate the clinical effectiveness of Solitaire AB stent thrombectomy for acute ischemic stroke (AIS). Methods A retrospective study was carried out in 94 AIS patients admitted in our department from November 2014 to January 2016. According to the treatment they received, they were divided into group A (Solitaire AB stent thrombectomy, n=40) and group B (conventional microcatheter mechanical thrombectomy, n=54). All patients were followed up for 3 months. Their pre- and post-operative nerve function indices were compared between the 2 groups. The therapeutic effects were evaluated by thrombolysis in cerebral infarction (TICI) perfusion scale, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (MRS). SPSS statistics 16.0 was used to perform the statistical analysis. Independent sample t test or Chi-square test was employed for intergroup comparison, while paired t test for intragroup comparison. Results There were no significant differences in the serum levels of neuron-specific enolase (NSE), central nerve specific protein (S100β), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) at the same time point between the 2 groups (P>0.05). In both groups, the serum levels of NSE, S100β, TNF-α and IL-6 were significantly elevated in 24 h post-operatively, and then decreased in 72 h than those before operation (P<0.05). In group A, there were 70.00%(28/40) patients of TICI grade Ⅲ, 17.50%(7/40) of TICI grade Ⅱ, 12.50%(5/40) of TICI grade 0-Ⅰ. And the percentages were 57.41%(31/54), 25.93%(14/54), and 16.67%(9/54) respectively in the patients of group B, without significantly diffe-rences when compared with those of group A (P=0.238). Though no significant difference was seen in NIHSS scores between group A and group B at same time point (P>0.05), the scores were obviously decreased in 1 and 2 weeks postoperatively than those before operation (P<0.05). After 3 months, there was no significant difference in the ratio of better prognosis between the 2 groups (80.00% vs 70.37%, P>0.05). Conclusion Solitaire AB stent thrombectomy shows similar efficacy as conventional mechanical thrombolysis in the treatment of AIS patients, but the operation is relatively complicated and difficult. Clinicians should choose rational surgical approaches according to patient′s condition.
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