摘要目的 探讨Sofia 远端通路导管抽吸术治疗急性动脉闭塞的效果。方法 选取2019年1月～2020年6月于江西省景德镇市第一人民医院接受取栓治疗的60 例急性动脉闭塞患者作为研究对象，通过随机数字表法分为对照组与研究组，每组各30 例，分别给予支架取栓治疗、Sofia 远端通路导管抽吸术治疗。比较两组患者的手术治疗情况、并发症发生情况、美国国立卫生研究院卒中量表（NIHSS）评分、神经内科医师护士常用判断病情伤残表（MRS）评分。结果 研究组患者穿刺到血管成功再通耗时短于对照组[（14.30±2.10 vs. 29.55±4.56）min]，差异有统计学意义（P<0.05）。研究组与对照组患者发病到血管成功再通耗时[（255.00±69.00 vs. 260.00±79.00）min]、1 次成功再通率（73.33% vs. 63.33%）及DSA 灌注评分（mTICI）2b/3 级（66.67% vs. 53.33%）、mTICI 3 级（40.00% vs. 33.33%）占比比较，差异无统计学意义（P>0.05）。研究组与对照组患者手术并发症总发生率（23.33% vs. 26.67%）比较，差异无统计学意义（P>0.05）。研究组与对照组患者术前NIHSS 评分[（11.26±3.90 vs. 11.28±3.88）分]比较，差异无统计学意义（P>0.05）；两组患者术后24、48 h 的NIHSS 评分均低于术前，差异有统计学意义（P<0.05）；研究组与对照组患者术后24 h 的NIHSS 评分[（10.61±3.68 vs. 10.59±3.70）分]、术后48 h 的NIHSS 评分[（9.85±3.44 vs. 9.87±3.42）分]比较，差异无统计学意义（P>0.05）。术后90 d，研究组MRS 评分<2 分24 例，≥2 分6 例，对照组MRS 评分<2 分25 例，≥2 分5 例；两组MRS 评分比较，差异无统计学意义（P>0.05）。结论 Sofia 远端通路导管抽吸术同支架取栓术比较，两种术式的安全性与疗效近似，均能有效改善患者神经功能缺损情况及预后质量，但是前者穿刺到血管成功再通耗时较短，操作更加简便，临床实际应用时，医护人员要根据患者实际情况做出合理选择。
Abstract： Objective To investigate the effect of Sofia distal access catheter aspiration in the treatment of acute arterial occlusion.Methods From January 2019 to June 2020,60 patients with acute arterial occlusion who received thrombectomy treatment in Jingdezhen No.1 People′s Hospital, Jiangxi Province were selected as the research objects. They were divided into the control group and the study group by the random number table method, with 30 cases in each group,and they were given stent thrombus removal treatment and Sofia distal access catheter aspiration treatment respectively.The surgical treatment, incidence of complications, the National Institutes of Health stroke scale (NIHSS) score, and the modified Rankin scale (MRS) score commonly used to judge the condition and disability by neurosurgeon and nurses were compared in the two groups. Results The time from puncture to successful recanalization in the study group was shorter than that in the control group ([14.30±2.10 vs. 29.55±4.56] min), the difference was statistically significant (P<0.05). There were on statistically significant differences in the time from onset to successful recanalization ([255.00±69.00 vs. 260.00±79.00] min), first-time success recanalization rate (73.33% vs. 63.33%), and proportions of DSA perfusion score (mTICI) 2b/3 (66.67% vs. 53.33%) and mTICI 3 (40.00% vs. 33.33%) between the study group and the control group (P>0.05). There was no significant difference in the total incidence of surgical complications between the study group and the control group (23.33% vs. 26.67%)(P >0.05). There was no significant difference in the NIHSS score before operation between the study group and the control group ([11.26±3.90 vs. 11.28±3.88] points)(P>0.05). The NIHSS scores of the two groups at 24 and 48 h after surgery were lower than those before surgery, and the differences were statistically significant (P<0.05). There were no statistically significant differences in the NIHSS scores at 24 h after surgery ([10.61±3.68 vs. 10.59±3.70] points) and 48 h after surgery ([9.85±3.44 vs. 9.87±3.42]points) between the study group and the control group (P>0.05). At 90 days postoperatively, there were 24 cases with MRS score <2 points and 6 cases with MRS score ≥2 points in the study group, and in the control group, 25 cases with MRS score <2 points, and 5 cases with MRS score ≥2 points, there was no significant difference in MRS score between the two groups (P>0.05). Conclusion After comparison of Sofia distal access catheter aspiration and stent thrombus removal, the safety and curative effect of the two procedures are similar. Both of them can effectively improve the neurological deficit and prognosis quality of patients. But the time from puncture to successful recanalization in the former is shorter, and the operation is simpler. In the clinical practice, the medical staff should make reasonable choices according to the actual situation of the patients.
Romano DG，Casseri T，Leonini S，et al.Single-center experience using the 3MAX or 4MAX reperfusion catheter for the treatment of acute ischemic stroke with distal arterial occlusions in patients not eligible for intravenous fibrinolysis[J].Radiol Med，2019，124（5）：408-413.
Crockett MT，Phillips TJ，Chiu AHY.Dual suction Headway27 microcatheter thrombectomy for the treatment of distal intracranial arterial occlusion strokes：initial experience with the micro-ADAPT technique[J].J Neurointerv Surg，2019，11（7）：714-718.
京公网安备 11010502046607号