改良颅内外血管搭桥术治疗缺血性脑血管病25例患者的临床疗效

doi:10.19854/j.cnki.1008-2425.2021.06.0012

摘要/Abstract

摘要： 目的观察改良颅内外血管搭桥术治疗缺血性脑血管病患者的疗效。方法回顾性收集2019年7月~2021年5月我院收治的25例缺血性脑血管病患者临床资料,所有患者均采用改良颅内外血管搭桥术进行治疗,术后观察14 d,出院后随访6个月。统计所有患者随访6个月疗效、住院期间并发症发生情况及随访情况,统计所有患者术前和术后14 d MRI灌注成像参数及术前、术后7 d、术后14 d、出院时及随访3个月、随访6个月mRS评分、NIHSS评分。结果随访6个月,25例缺血性脑血管病患者经改良颅内外血管搭桥术治疗后总有效率为88.00%(22/25)。术后14 d,缺血性脑血管病患者脑血流量高于术前(P<0.05),平均通过时间、缺血侧达峰时间短于术前(P<0.05)。缺血性脑血管病患者mRS评分、NIHSS评分比较,术后7 d、术后14 d、出院时、随访3个月、随访6个月均低于术前,且术后各时间点呈降低趋势,不同时间点比较,差异具有统计学意义(P<0.05)。住院期间,25例缺血性脑血管病患者术后24 h内发生1例手术部位薄层硬膜下血肿,1例发生局造性脑梗死,2例发生高灌注综合症。结论改良颅内外血管搭桥术治疗缺血性脑血管病患者,可有效改善患者临床症状及血流灌注情况,降低并发生的发生,促进患者神经功能好转,具有较好的治疗效果。

关键词: 缺血性脑血管病, 改良颅内外血管搭桥术, 神经功能, 血管成像

Abstract: Objective To observe the effect of modified intracranial and extracranial vascular bypass in patients with ischemic cerebrovascular disease.Methods Clinical data of 25 patients with ischemic cerebrovascular disease admitted to our hospital from July 2019 to May 2021 were retrospectively collected.All patients were treated with modified intracranial and extracranial vascular bypass.The patients were observed for 14 d after operation and followed up for 6 months follow-up.The efficacy of all patients 6 months follow-up,the incidence of complications during hospitalization and follow-up were counted,and the parameters of MRI perfusion imaging before and after operation 14 d,as well as scores of mRS and NIHSS before operation,7 d after operation,14 d after operation,at discharge,3 months of follow-up and 6 months of follow-up were counted.Results After 6 months of follow-up,the total effective rate of 25 patients with ischemic cerebrovascular disease treated by modified intracranial and extracranial vascular bypass was 88.00% (22/25).14 d after operation,the cerebral blood flow of patients with ischemic cerebrovascular disease was higher than that before operation (P<0.05),and the mean passage time and peak time of ischemic side were shorter than that before operation (P<0.05).The comparison of mRS score and NIHSS score of patients with ischemic cerebrovascular disease showed 7 d after surgery,14 d after surgery,at discharge,3 months follow-up and 6 months follow-up were lower than before surgery,and there was a decreasing trend at all postoperative time points,and the difference was statistically significant at different time points (P<0.05).In 25 patients with ischemic cerebrovascular disease,There were 1 patients with thin subdural hematoma and 1 patient with local cerebral infarction and 2 patient with hyperperfusion syndrome within 24h after operation.Conclusion Modified intracranial and extracranial vascular bypass for the treatment of patients with ischemic cerebrovascular disease can effectively improve the clinical symptoms and blood perfusion,reduce the occurrence of complications,promote the improvement of patients' neurological function,and has a good therapeutic effect.

Key words: Ischemic cerebrovascular disease, Modified intracranial and extracranial vascular bypass, Neurological function, Vascular imaging

中图分类号:

R743.34

滑祥廷, 张超勇, 巴永锋, 范奎, 白如江, 李玉峰. 改良颅内外血管搭桥术治疗缺血性脑血管病25例患者的临床疗效[J]. 立体定向和功能性神经外科杂志, 2021, 34(6): 371-374.

Hua Xiangting, Zhang Chaoyong, Ba Yongfeng, et al.. Clinical efficacy of modified extracranial and extracranial vascular bypass grafting in the treatment of 25 patients with ischemic cerebrovascular disease[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2021, 34(6): 371-374.

参考文献

[1] 魏艳花,蔺慕会.血管内支架植入术治疗缺血性脑血管病的疗效观察[J].广西医科大学学报,2018,35(1):109~111.
[2] 杨志刚,程伟,潘春联.神经介入联合静脉溶栓治疗缺血性脑血管病的临床疗效[J].医学综述,2018,24(18):3733~3736.
[3] 许佳平,卞科宇,金华锋.PTAS对缺血性脑血管病患者认知、脑血流参数及神经功能的影响[J].心脑血管病防治,2019,19(5):405~407.
[4] 仇宇宁,杨波,张静,等.缺血型烟雾病间接搭桥与联合搭桥造影及疗效对比分析[J].中风与神经疾病杂志,2018,35(6):545~547.
[5] 饶明俐.中国脑血管病防治指南:试行版[M].北京:人民卫生出版社,2007:65~67.
[6] 贺敬红,乔英,张华,等.全脑CT灌注联合4D-CTA对颞浅动脉-大脑中动脉搭桥术血流动力学的应用价值[J].中西医结合心脑血管病杂志,2019,17(11):1732~1735.
[7] 付华文,李光建.数字减影血管造影联合神经介入溶栓术治疗缺血性脑血管疾病临床效果观察[J].实用医院临床杂志,2019,16(6):178~182.
[8] 杨杨,陈珍.颅内外血管搭桥手术对颅内动脉瘤患者的有效性及患者NIHSS评分的影响[J].中华保健医学杂志,2019,21(4):383~385.
[9] 胡晓华.头颈联合CTA技术与血管曲面重建在缺血性脑血管病诊断中的临床应用[J].心脑血管病防治,2020,20(3):326~327.
[10] 赵启媛,金平,陈生,等.CT灌注成像在急性缺血性脑血管病中的诊断价值[J].安徽医学,2018,39(7):841~844.
[11] 马高亭,缪中荣.抗血小板治疗在血管内治疗缺血性脑血管病中的应用[J].中国卒中杂志,2020,15(2):202~208.
[12] 李亚雄,樊丰势,崔志强,等.改良颅内外血管搭桥术治疗缺血性脑血管病的临床研究[J].中国微侵袭神经外科杂志,2020,25(9):385~388.
[13] 张文高,王海霞,王芝静,等.颅内外血管搭桥治疗烟雾病及外周血内皮祖细胞超顺磁性氧化铁颗粒标记的实验研究[J].解剖学研究,2017,39(4):272~276.
[14] 周小平,严剑,唐斌,等.烟雾病颅内外血管搭桥术中血管压力变化与疗效的相关性分析[J].中华神经外科杂志,2019(7):673~675.
[15] 黄亚波,周鹏,韩庆东,等.颅内外血管搭桥联合动脉瘤孤立术治疗颈内动脉床突旁大型和巨大型动脉瘤[J].中华神经外科杂志,2018,34(12):1249~1253.
[16] 王志勇,朱耀祖,周有东,等.烟雾病患者颅内外血管搭桥术术中神经电生理监测的意义[J].神经损伤与功能重建,2017,12(5):443~444.