本文關鍵詞： 急性腦梗死 介入血運重建 臨床療效和安全性　出處：《寧夏醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的觀察我院超早期急性腦梗死介入血運重建的臨床療效及其安全性;觀察我院超早期急性腦梗死血運重建的救治綠色通道的運行情況;為我院進一步提高超早期急性腦梗死介入血運重建的臨床療效及其安全性和救治綠色通道的質(zhì)量改進提供依據(jù)。方法回顧性分析2015年11月到2016年11月我院11例行超早期急性腦梗死介入血運重建患者的一般臨床資料、發(fā)病到血管再通的各個環(huán)節(jié)所用時間、血管閉塞的部位、術后即刻mTICI血流分級和顱腦CT、術后影像學檢查(顱腦CT、CTA、MRI、MRA)、術前和術后各個時間點(術后即刻、術后24h、術后3天、術后1周、術后2周、術后3個月)NIHSS評分,對我院超早期急性腦梗死介入血運重建救治的各個環(huán)節(jié)所用時間和腦卒中綠色通道流程的時間管理目標以及超早期急性腦梗塞介入血運重建的臨床療效及其安全性進行分析。結果我院介入血運重建患者與腦卒中綠色通道流程的時間管理目標相比就診到完成顱腦CT檢查的時間達標比率為22.2%,就診到靜脈溶栓開始時間均未達標,就診到動脈置鞘時間達標比率為36.4%,動脈置鞘到開始動脈取栓或溶栓時間均達標,動脈置鞘到閉塞血管再通時間均達標;血管再通情況用mTICI血流分級評價,再通成功率為72.7%;癥狀性顱內(nèi)出血率為37.5%;術前、術后即刻、術后24h、術后3天、術后1周、術后2周、術后3個月的NIHSS評分呈下降趨勢,且配對t檢驗顯示術后各組分別與術前相比差異均有統(tǒng)計學意義(p0.05);術后90d神經(jīng)功能預后用mRS評分評價,預后良好率為62.5%,預后較差率為12.5%,死亡率為25%;血管再通成功的患者預后良好率為62.5%,預后較差率為12.5%,死亡率為25%,再通不成功患者中無預后良好患者,預后較差率為33.3%,死亡率為66.7%;8例血管再通成功的患者中有4例術后完善CTA或MRA檢查,均無血管再閉塞。結論1.我院目前腦卒中綠色通道運行中在動脈置鞘到開始取栓、動脈置鞘到閉塞血管再通時間達到腦卒中綠色通道流程的時間管理目標;2.我院臨床應用介入血運重建技術治療超早期急性腦梗死初步總結是安全的、有效的;3.我院臨床應用介入血運重建技術可以提高大動脈閉塞的血管再通率,血管再通成功的患者臨床預后越好。
[Abstract]:Objective to observe the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction in our hospital. To observe the operation of green channel in the treatment of acute cerebral infarction in our hospital. To provide the basis for further improving the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction and the improvement of the quality of the treatment of green channels. Methods retrospective analysis was made from November 2015 to 2016. In November, 11 patients with super-early acute cerebral infarction underwent interventional revascularization. The time to recanalization, the location of occlusion, the mTICI blood flow grading and craniocerebral CTS immediately after operation, and the imaging examination after operation. NIHSS scores were obtained at all time points before and after operation (immediate, 24 hours, 3 days, 1 week, 2 weeks and 3 months after operation). The objective of time management for the treatment of each link of interventional revascularization of ultra-early acute cerebral infarction and the time management of green channel flow of stroke, and the clinical efficacy and safety of interventional revascularization of ultra-early acute cerebral infarction in our hospital. Results compared with the time management target of green channel process of stroke, the ratio of time to complete CT examination in patients with interventional revascularization in our hospital was 22.2%. The starting time of venous thrombolytic therapy was not up to the standard. The rate of reaching the standard of arterial sheath insertion time was 36.4%, and the time from arterial sheath placement to beginning artery thrombolysis or thrombolysis was up to standard. The recanalization time of artery sheath to occlusive vessel was up to standard. The vascular recanalization was evaluated by mTICI blood flow grading. The successful rate of recanalization was 72.7%. The rate of symptomatic intracranial hemorrhage was 37.5%. Before, immediately after operation, 24 hours after operation, 3 days after operation, 1 week after operation, 2 weeks after operation, and 3 months after operation, the NIHSS score showed a downward trend. The paired t test showed that there were significant differences between the groups after operation and those before operation (P 0.05). 90 days after operation, the prognosis of nerve function was evaluated by mRS score. The good prognosis rate was 62.5%, the poor prognosis rate was 12.5%, and the mortality rate was 25.5%. The good prognosis rate was 62.5%, the poor prognosis rate was 12.5%, and the mortality rate was 25% in the patients with successful recanalization. The poor prognosis rate was 33.3% in the patients with unsuccessful recanalization. The mortality rate was 66.7; Of the 8 patients with successful revascularization, 4 had improved CTA or MRA examination after operation, and none of them were re-occluded. Conclusion 1. At present, during the operation of green channel of stroke in our hospital, the artery sheath is placed to begin to take thrombus. 2. The time of recanalization from artery sheath to occluded vessel reached the goal of time management of green channel flow in stroke. 2. It is safe and effective to apply interventional revascularization technique in the treatment of ultra-early acute cerebral infarction in our hospital. 3. The clinical application of interventional revascularization in our hospital can improve the recanalization rate of large artery occlusion, and the better the prognosis of the patients with successful revascularization.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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