Department of Interventional, Yantai Mountain Hospital, Yantai, 264003 Shandong, China.
Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong, China.
Dis Markers. 2022 Sep 26;2022:1686891. doi: 10.1155/2022/1686891. eCollection 2022.
To explore the application value of standardized perioperative management in mechanical thrombectomy for acute cerebral infarction.
98 patients with acute cerebral infarction admitted to our hospital from January 2019 to January 2022 were selected as the study sample in this study, and all patients were given the standardized perioperative management. According to the interventional methods, they were divided into the thrombolytic treatment group (arteriovenous combined thrombolysis, = 49) and mechanical thrombectomy group (mechanical thrombectomy, = 49) to compare the nerve function, limb function, thrombolysis in myocardial infarction (TIMI) flow grade, symptomatic intracranial hemorrhage within 24 hours, acute vascular reocclusion, and the death status within 1 year and incidence of adverse events in 90 days of the two groups after treatment.
After treatment, the values of brain symmetry index (BSI) and power ratio indices (DTABR) in the two groups were obviously lower than those before treatment ( < 0.05), and the values of BSI and DTABR in the mechanical thrombectomy group were lower than those in the thrombolytic treatment group ( < 0.05). According to the statistical data of National Institutes of Health Stroke Scale (NIHSS) score in patients, the NIHSS scores of the two groups after treatment were visibly decreased ( < 0.05), while the NIHSS score in the mechanical thrombectomy group after treatment was lower than that in the thrombolytic treatment group ( < 0.05). The proportion of modified Rankin scale (mRS) score < 3 in the mechanical thrombectomy group was distinctly higher than that in the thrombolytic treatment group ( < 0.05). The proportion of TIMI flow grade ≥ 2 in the mechanical thrombectomy group was significantly higher than that in the thrombolytic treatment group ( < 0.05). The rate of symptomatic intracranial hemorrhage within 24 hours in the mechanical thrombectomy group was lower than that in the thrombolytic treatment group ( < 0.05), with the indistinctive difference between the two groups ( > 0.05). The incidence of acute vascular reocclusion in the mechanical thrombectomy group was markedly lower than that in the thrombolytic treatment group ( < 0.05). There was no significant difference in 1-year mortality between the two groups ( > 0.05). In the mechanical thrombectomy group, there were 1 case of gingiva bleeding, 1 case of hemorrhinia, and 2 cases of recurrent cerebral infarction in 90 days, with a total of 4 cases (8.16%), while in the thrombolytic treatment group, there were 4 cases of gingiva bleeding, 4 cases of hemorrhinia, and 15 cases of recurrent cerebral infarction in 90 days, with a total of 23 cases (46.94%), indicating that the incidence of adverse events in 90 days in the mechanical thrombectomy group was significantly lower than that in the thrombolytic treatment group ( < 0.05).
The standardized perioperative management is effective in patients with acute cerebral infarction who were treated with arteriovenous combined thrombolysis or mechanical thrombectomy, which can improve the neurological function and physical function of patients. However, the mechanical thrombectomy has a better improvement effect on the neurological function and physical function of patients, with the relatively better safety, thrombolytic effect, and long-term prognosis.
探讨规范化围手术期管理在急性脑梗死机械取栓中的应用价值。
选取 2019 年 1 月至 2022 年 1 月我院收治的 98 例急性脑梗死患者作为研究样本，所有患者均给予规范化围手术期管理。根据介入方法分为溶栓治疗组（动静脉联合溶栓，n=49）和机械取栓组（机械取栓，n=49），比较两组患者神经功能、肢体功能、心肌梗死溶栓治疗（TIMI）血流分级、24 小时内症状性颅内出血、急性血管再闭塞、治疗后 1 年内死亡状态及 90 天内不良事件发生率。
治疗后，两组患者脑对称指数（BSI）和功率比指数（DTABR）值明显低于治疗前（<0.05），机械取栓组 BSI 和 DTABR 值低于溶栓治疗组（<0.05）。根据患者国立卫生研究院卒中量表（NIHSS）评分的统计数据，两组患者治疗后的 NIHSS 评分明显降低（<0.05），而机械取栓组治疗后的 NIHSS 评分低于溶栓治疗组（<0.05）。机械取栓组改良 Rankin 量表（mRS）评分<3 分的比例明显高于溶栓治疗组（<0.05）。机械取栓组 TIMI 血流分级≥2 级的比例明显高于溶栓治疗组（<0.05）。机械取栓组 24 小时内症状性颅内出血发生率低于溶栓治疗组（<0.05），两组间差异无统计学意义（>0.05）。机械取栓组急性血管再闭塞发生率明显低于溶栓治疗组（<0.05）。两组 1 年内死亡率差异无统计学意义（>0.05）。机械取栓组 90 天内牙龈出血 1 例、鼻出血 1 例、脑梗死复发 2 例，共 4 例（8.16%），溶栓治疗组牙龈出血 4 例、鼻出血 4 例、脑梗死复发 15 例，共 23 例（46.94%），表明机械取栓组 90 天内不良事件发生率明显低于溶栓治疗组（<0.05）。
规范化围手术期管理对接受动静脉联合溶栓或机械取栓治疗的急性脑梗死患者有效，可改善患者的神经功能和肢体功能。但机械取栓对患者神经功能和肢体功能的改善效果更好，安全性、溶栓效果及远期预后相对更好。
