血管內介入治療與單純藥物治療用于缺血性腦血管病的臨床效果比較

祖合熱阿依·牙合甫 黨輝 王成鳳 陳偉

[摘要] 目的 探究血管內介入治療與單純藥物治療在缺血性腦血管病中的療效差異。 方法 隨機抽取2013年1月～2016年1月于新疆維吾爾自治區人民醫院確診為缺血性腦血管病（ICVD）的患者120例，將其隨機分為觀察組與對照組，每組各60例。觀察組患者在給予藥物治療的基礎上，再施行血管內介入治療；對照組患者僅使用藥物治療。治療1年后，對兩組患者進行隨訪，分別評估兩組患者的血液動力學改善情況、神經功能缺損評分（NIHSS）、血管狹窄程度變化和不良反應發生率。 結果 治療1年后，觀察組椎動脈、基底動脈、頸內動脈及頸總動脈收縮期峰流速中的治療效果均顯著優于對照組，差異有高度統計學意義（P < 0.01）；觀察組NIHSS評分低于對照組，差異有高度統計學意義（P < 0.01）；治療后觀察組血管狹窄程度顯著低于對照組，差異有高度統計學意義（P < 0.01）；且觀察組不良發應發生率低于對照組，差異有統計學意義（P < 0.05）。 結論 血管介入治療在改善ICVD患者血液動力學情況、NIHSS評分、血管狹窄程度變化和不良反應發生率方面明顯優于單純藥物治療，值得在臨床上推廣。

[關鍵詞] 缺血性腦血管；血管內介入；單純藥物治療；神經功能缺損評分

[中圖分類號] R743.31 [文獻標識碼] A [文章編號] 1673-7210（2018）03（b）-0064-04

Comparison of the clinical effects of intravascular interventional therapy and simple drug therapy on ischemic cerebrovascular disease

Zuhereayi·yahefu1 DANG Hui1 WANG Chengfeng1 CHEN Wei2

1.Department of Neurology， the People′s Hospital of Xinjiang Autonomous Region， Xinjiang Uygur Autonomous Region， Urumqi 830000， China； 2.Department of Neurosurgery， the First Affiliated Hospital of Xi′an Jiao Tong University， Shaanxi Province， Xi′an 710061， China

[Abstract] Objective To explore the clinical effect of endovascular treatment and simple drug treatment in the patients with ischemic cerebrovascular disease. Methods One hundred and twenty patients with ICVD in the People′s Hospital of Xinjiang Autonomous Region from January 2013 to January 2016 were randomly drawn， and they were randomly divided into the observation group and the control group， 60 cases in each group. The patients in the observation group were treated with endovascular treatment on the basis of drug treatment， and the control group was only treated with single drugs treatment. One year later， patients of two groups were followed up. The hemodynamic improvement， NIHSS， degree of vascular stenosis and the incidence of adverse reactions were evaluated in two groups， respectively. Results After treatment for one year， the effect of the part of the vertebral artery， basilar artery， internal carotid artery and carotid artery peak systolic velocity in the observation group were better than that in the control group， the differences were statistically significant （P < 0.01）. The NIHSS of the observation group was lower than that in the control group， the difference was statistically significant （P < 0.01）. The degree of vascular stenosis after treatment was significantly lower than the control group， the difference was statistically significant （P < 0.01）. The incidence of adverse reaction in the observation group was also lower than that of the control group， the difference was statistically significant（P < 0.05）. Conclusion Endovascular treatment is superior to simple drug therapy in terms of the hemodynamic improvement， NIHSS， vascular stenosis degree and incidence of adverse reactions in the treatment of ICVD， it is worthy of clinical promotion.

[Key words] Ischemic cerebrovascular； Endovascular treatment； Simple drug therapy； NIHSS

缺血性腦血管病（ischemic cerebrovascular disease，ICVD）是一種常見于老年人的血管疾病，通常具有“四高一低”的發病特點，即發病率高、致殘率高、致死率高、復發率高以及痊愈性低[1-2]。ICVD主要是由動脈粥樣硬化（atherosclerosis，AS）引起的血管狹窄所致，其主要治療手段有藥物治療、手術治療以及血管內介入治療[3]。傳統的藥物治療是治療ICVD的基礎，但是存在一定的局限性，并不能治療嚴重的狹窄病變且復發率高；而手術治療由于其對ICVD患者的創傷較大、術后并發癥較多的缺點，并不常用于ICVD的治療[4]。目前，血管內支架置入術（carotid artery stenting，CAS）是主要治療AS的手段，具有創傷小、安全性高以及療效好等特點[5]。……