急性缺血性脑卒中机械取栓后造影剂渗出的临床研究

王大巍; 高阿芳; 束汉生; 王昊; 张辉

doi:10.13898/j.cnki.issn.1000-2200.2019.09.008

急性缺血性脑卒中机械取栓后造影剂渗出的临床研究

Clinical study on contrast agent extravasation in acute ischemic stroke patients after machinery thrombectomy

摘要

摘要:
目的探讨急性缺血性脑卒中机械取栓后造影剂外渗形成的原因及与预后相关性。
方法选取急性大血管闭塞经支架取栓后责任血管成功再通病人40例，分为无造影剂外渗组、渗出型造影剂外渗组和出血型造影剂外渗组，统计3组发病到再通时间（OTR）、穿刺到再通时间（PTR）、术中拉栓次数、造影剂外渗的体积、吸收的时间、Alberta卒中项目早期CT评分、术后24 h美国国立卫生研究院脑卒中量表（NIHSS）评分、术后3个月生活能力（mRS）评分。
结果3组Alberta卒中项目早期CT评分、OTR、PTR、24 h NIHSS评分及术后3个月mRS评分差异均有统计学意义（P < 0.01）；渗出组造影剂渗出体积低于出血组（P < 0.01），而2组成功再通拉栓次数、造影剂完全吸收时间差异无统计学意义（P>0.05）。
结论缩短缺血性卒中院内和院外的就诊时间，熟练手术操作技术，从而减少术后造影剂外渗及病人术后出血转化的机会，改善预后。

Abstract:
ObjectiveTo explore the reasons of contrast agent extravasation in acute ischemic stroke patients after mechanical thrombectomy, and analyze its correlation with prognosis.
MethodsForty acute large vessel occlusion patients with successful re-opened of offending vessels after thrombectomy were divided into the non-contrast agent extravasation group, exudative contrast agent extravasation group and hemorrhagic contrast agent extravasation group.The from onset to revascularization time(OTR), from puncture to revascularization time(PTR), number of intraoperative pulling bolt, volume of extravasated contrast agent, time of absorption, postoperative 24 h score of national institute of health stroke scale(NIHSS) and postoperative 3 months score of modified Rankin scale(mRS) among three groups were compared.
ResultsThe differences of the OTR, PTR, 24 h NIHSS score, ASPECT score and 3-month mRS score were statistically significant among three groups(P < 0.01).The volume of contrast agent exudation in exudation group was lower than that in bleeding group(P < 0.01), while the difference of the total absorption time of contrast agent, number of successful pulling bolt recanalization between two groups were not statistically significant(P>0.05).
ConclusionsShortening the length of hospital stay and outpatient of patients with ischemic stroke, knowing surgical technique and reducing the number of pulling plug can reduce the probability of postoperative contrast agent extravasation and cerebral hemorrhage transformation, and improve the prognosis.

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