临床和实验医学杂志2024，Vol.23Issue(12) ：1257-1261.DOI:10.3969/j.issn.1671-4695.2024.12.007

药物涂层球囊扩张与支架置入联合方案治疗椎动脉狭窄患者的效果

Efficacy of a combined regimen of drug-coated balloon dilatation and stent placement in the treatment of patients with vertebral artery stenosis

朱玉胜 龙昊 卢曹坤 李子靳
临床和实验医学杂志2024，Vol.23Issue(12) ：1257-1261.DOI:10.3969/j.issn.1671-4695.2024.12.007
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药物涂层球囊扩张与支架置入联合方案治疗椎动脉狭窄患者的效果

Efficacy of a combined regimen of drug-coated balloon dilatation and stent placement in the treatment of patients with vertebral artery stenosis

朱玉胜 1龙昊 2卢曹坤 1李子靳1
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作者信息

  • 1. 德驭医疗马鞍山总医院介入血管外科 安徽 马鞍山 243000
  • 2. 马鞍山十七冶医院介入治疗科 安徽 马鞍山 243000
  • 折叠

摘要

目的 观察药物涂层球囊(DCB)扩张与支架置入联合方案治疗椎动脉狭窄患者的效果.方法 前瞻性选取2021年1月至2023年1月马鞍山十七冶医院收治的80例椎动脉狭窄患者,按照随机数字表法将其分为观察组和对照组,每组各40例.对照组给予普通球囊扩张联合支架置入方案,观察组给予DCB扩张联合支架置入方案.比较两组术前、术后90 d椎动脉颅内段血流动力学[舒张末期峰值血流速度(EDV)、收缩期峰值血流速度(PSV)、搏动指数(PI)]、脑血流灌注[相对平均通过时间(rMTT)、相对达峰时间(rTTP)、相对脑血流量(rCBF)、相对脑血容量(rCBV)]、神经功能[美国国立卫生院神经功能缺损(NIHSS)评分]与日常生活能力(Barthel指数)水平,记录两组并发症发生情况.结果 术后90 d,观察组的EDV、PSV分别为(37.98±4.41)、(71.76±6.97)cm/s,均低于对照组[(41.52±5.52)、(75.89±8.11)cm/s],PI 为 0.82±0.13,高于对照组(0.76±0.11),差异均有统计学意义(P＜0.05).术前,两组脑血流灌注指标比较,差异均无统计学意义(P＞0.05).术后90 d,观察组的rMTT、rTTP分别为(1.01±0.12)、(0.96±0.11)s,均低于对照组[(1.08±0.14)、(1.04±0.12)s],rCBF、rCBV 分别为(47.74±5.22)mL·100 mg-1·min-1、(4.11±0.48)mL/100 g,均高于对照组[(45.28±4.96)mL·100 mg-1·min-1、(3.87±0.44)mL/100 g],差异均有统计学意义(P＜0.05).术前,两组NIHSS评分、Barthel指数比较,差异均无统计学意义(P＞0.05).术后90 d,观察组NIHSS评分为(8.57±2.01)分,低于对照组[(11.05±2.56)分],观察组Barthel指数为(68.74±7.01)分,高于对照组[(57.95±6.23)分],差异均有统计学意义(P＜0.05).观察组术后再狭窄发生率为5.00％,低于对照组(20.00％),差异有统计学意义(P＜0.05);两组高灌注综合征、支架脱落及移位、脑梗死、脑出血、穿刺部位并发症等发生率比较,差异均无统计学意义(P＞0.05).结论 DCB扩张联合支架置入方案可改善椎动脉狭窄患者脑血流,改善神经功能,提高日常生活能力,降低术后再狭窄率.

Abstract

Objective To observe the efficacy of a combined regimen of drug-coated balloon(DCB)dilatation and stent placement in patients with vertebral artery stenosis.Methods A total of 80 patients with vertebral artery stenosis admitted to Maanshan No.17 Metallurgical Hospital from January 2021 to January 2023 were seleted and prospectively divided into the observation group and the control group according to the random number table method,each group 40 cases.The control group was given conventional balloon dilatation combined with stent implantation,and the observation group was given DCB dilatation combined with stent implantation.The differences of hemodynamics of the intracranial segment of the vertebral artery[end diastolic peak blood flow velocity(EDV),systolic peak blood flow velocity(PSV),pulsatile index(PI)],cerebral blood flow perfusion[relative mean transit time(rMTT),relative peak time(rTTP),relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV)],neurological function[National Institute of Health stroke scale(NIHSS)score]and daily living ability(Barthel index)before operation and 90 days after operation were compared between the two groups,and the incidence of complications was recorded.Results At 90 days after operation,the EDV and PSV of the observation group were(37.98±4.41)and(71.76±6.97)cm/s,respectively,which were lower than those of the control group[(41.52±5.52)and(75.89±8.11)cm/s],the PI was 0.82±0.13,which was higher than that of the control group(0.76±0.11),and the differences were statistically significant(P＜0.05).At 90 days after operation,the rMTT,rTTP values of the observation group were(1.01±0.12)and(0.96±0.11)s,respectively,which were lower than those of the control group[(1.08±0.14)and(1.04±0.12)s],the rCBF and rCBV of the observation group were(47.74±5.22)mL·100 mg-1·min-1 and(4.11±0.48)mL/100 g,respectively,which were higher than those of the control group[(45.28±4.96)mL·100 mg-1·min-1 and(3.87±0.44)mL/100 g],and the differences were statistically significant(P＜0.05).At 90 days after operation,the NIHSS score of the observation group was(8.57±2.01)points,which was lower than that of the control group[(11.05±2.56)points],and the Barthel index of the observation group was(68.74±7.01)points,which was higher than that of the control group[(57.95±6.23)points],and the differences were statistically significant(P＜0.05).The incidence of postoperative restenosis in the observation group was 5.00％,which was lower than that in the control group(20.00％),and the difference was statistically significant(P＜0.05);there were no statistically significant differences in the incidence of hyperperfusion syndrome,stent detachment and displacement,cerebral infarction,cerebral hemorrhage,and complications at the puncture site between the two groups(P＞0.05).Conclusion DCB dilatation combined with stent implantation can improve cerebral blood flow,improve nerve function,en-hance daily living ability and reduce postoperative restenosis in patients with vertebral artery stenosis.

关键词

椎动脉/支架/日常生活活动/药物涂层球囊扩张/脑血流/神经功能

Key words

Vertebral artery/Stents/Ability of daily living/Drug-coated balloon dilatation/Cerebral blood flow/Nerve function

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基金项目

中国金属学会冶金安全与健康分会健康卫生科研项目(JKWS202038)

出版年

2024
临床和实验医学杂志
首都医科大学附属北京友谊医院

临床和实验医学杂志

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ISSN：1671-4695
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