急性心源性脑梗塞桥接治疗临床疗效分析

Clinical Effect Analysis of Bridging Therapy for Acute Cardiogenic Cerebral Infarction

摘要: 目的：本研究旨在探讨静脉溶栓桥接动脉机械碎栓、取栓术治疗急性心源性脑梗塞的临床疗效，评估桥接治疗急性心源性脑栓塞的安全性及有效性。方法：选取我院2016年1月1日至2018年1月1日收入院的16例急性心源性脑栓塞患者，所有患者在静脉溶栓时间窗内给予重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator, rt-PA)静脉溶栓治疗(剂量为0.9 mg/Kg，先予以10%的剂量静脉推注，剩余的90%持续静脉滴注，共60分钟)，之后在全麻下行动脉内机械碎栓、取栓术，通过改良脑梗死溶栓血流分级(modified Thrombolysis In Cerebral Infarction, mTICI)评估血管再通情况，将mTICI分级2b/3级作为急性心源性脑栓塞血管内治疗成功标准。记录所有患者血管闭塞的部位，患者的一般资料(如年龄、性别)。记录患者治疗前、治疗24小时后的美国国立卫生研究院卒中量表(National Institute of Health stroke scale, NIHSS)评分；术后3个月电话或门诊随访患者，记录患者90天后改良Rankin量表(modified Rinkin Scale, mRS)评分来评估预后，记录预后良好率(mRS 0~2分)。结果：16例诊断为急性心源性脑栓塞的患者，男10例，女6例，年龄49~70岁，平均年龄(60.81 ± 6.28，岁)。术前NIHSS评分(17.19 ± 3.43)分，术后24 h NIHSS评分(11.88 ± 3.61)，其中14例为大脑中动脉闭塞，2例为基底动脉闭塞，16例患者术后血管均再通(TICI ≥ 2 b)；其中mRS评分0~2级12例。3个月内死亡率为12.5%。结论：本研究表明rt-PA静脉溶栓联合机械取栓可提高患者血管再通率，可显著改善急性心源性脑栓塞的短期神经功能和远期预后的方法，但尚需更大样本的研究进一步探索。

Abstract: Objective: To investigate the clinical efficacy of bridging therapy for acute cardiogenic cerebral infarction, and to evaluate its safety and efficacy. Methods: To select 16 cases of patients with acute cardiogenic cerebral infarction from January 1, 2016 to January 1, 2018. All of the patients in the time window are given the recombinant tissue plasminogen activator (rt-PA) for intravenous thrombolysis (total dosage is 0.9 mg/Kg; 10% of them were intravenous injection, the remaining were continuous intravenous drip in 60 minutes). Then, the mechanical thrombectomy was performed under general anesthesia. Modified Thrombolysis in Cerebral Infarction (mTICI) was used to assess vascular recanalization, and the grade 2b/3 of it was used as the success criteria for endovascular treatment of acute cardiogenic cerebral infarction. The occlusion site and general in-formation (such as age and gender) of all patients were recorded. The National Institute of Health stroke scale score (NIHSS) was recorded before and 24 hours after treatment. Patients were fol-lowed up by telephone or outpatient service 3 months after surgery, and the modified Rinkin Scale score (mRS) after 90 days was recorded to evaluate the prognosis, and the rate of good prognosis (mRS 0 - 2 points) was recorded. Results: 16 patients were diagnosed as acute cardiogenic cerebral infarction, of which 10 were males and 6 were females, aged 49 - 70 years old, with the average age (60.81 ± 6.28 years old). Preoperative NIHSS score (17.19 ± 3.43), and postoperative NIHSS score (11.88 ± 3.61) were obtained. Among them, 14 cases were middle cerebral artery occlusion, 2 cases were basilar artery occlusion, and 16 cases were recanalization (TICI 2b). Twelve patients were graded 0~2 mRS score. The three-month mortality rate was 12.5%. Conclusion: The study shows that rt-PA combined with mechanical thrombolysis can improve the patients’ vascular recanalization rate and significantly improve the short-term neurological function and long-term prognosis of acute cardiogenic cerebral embolism, but it needs further exploration in a larger sample.