中国急性缺血性卒中血管内治疗现状初步调查

摘要/Abstract

摘要：

目的初步调查我国急性缺血性卒中（acute ischemic stroke，AIS）血管内治疗的现状。方法在中国卒中中心联盟急性缺血性卒中血管内治疗协作组（Acute I schemic S troke C orporation Group of Endovascular Treatment，ANGEL）的首批中心中，采取调查问卷方式，对各医院的急性缺血性卒中血管内治疗负责人进行问卷调查。结果参与调查中心110家，遍布国内25省，64个城市，三级甲等医院90家，三级乙等医院13家，二级医院7家，61.2%的医院由神经内科实施AIS血管内治疗，18.0%由神经外科实施。所有中心均可实现 24 h的电子计算机断层扫描（computed tomography，CT）检查及数字减影血管成像（digital subtraction angiography，DSA），但24 h CT血管成像（CT angiography，CTA）检查仅为59.1%，24 h磁共振（magnetic resonance，MR）检查为30%。调查中心过去1年内治疗患者的总例数为2522例，完成50例以上的中心16 家（14.5%）。AIS年治疗10例以上的中心中：血管内治疗后出血比率<5%最多，占45.7%。血管内治疗后的再通比率81%～90%最多，占32.9%。90 d良好预后比率50%～60%最多，占33.8%。再通率60%以下的中心占8.6%，术后颅内出血10%以上占24.3%，90 d功能独立[改良Rankin量表评分（modified Rankin Scale，mRS）0～2]在40%以下占8.8%。培训内容排名前3位的为术中决策及突发问题处理，急诊治疗材料选择和技术规范，以及并发症预防和处理。结论近年，国内AIS血管内治疗数量在显著增加，24 h可及的多模式的影像检查仍有待普及。血管内治疗出血并发症、再通率及良好预后仍有待改进，开展规范的培训及质量监控是关键。

文章导读： 调查我国急性缺血性卒中血管内治疗现状，为规范AIS血管内治疗，开展针对性培训奠定了基础。

关键词: 急性缺血性卒中; 血管内治疗; 规范化培训; 质量监控

Abstract:

Objective To investigate the endovascular treatment status of acute ischemic stroke (AIS) in China. Methods A survey questionnaire was conducted among the leaders of the first batch of centers of Acute Ischemic Stroke Corporation Group of Endovascular Treatment (ANGEL). Results Among the 110 centers from 64 cities of 25 provinces, 90 centers were level 3 A hospitals, 13 centers were level 3 B hospitals and 7 centers were level 2 hospitals. Endovascular treatment of acute ischemic stroke was performed by Neurology Department in 61.2% centers and by Neurosurgery Department in 18.0% centers. All the centers could perform 24 h computed tomography (CT) and digital subtraction angiography (DSA). However, 59.1% centers could perform 24 h CT angiography (CTA) and 30% centers could perform 24 h magnetic resonance (MR). The total number of cases undergoing endovascular treatment was 2522 of all the centers, and 16 centers (14.5%) performed more than 50 cases. In centers with more than 10 cases a year, 45.7% of centers with a hemorrhage after treatment of less than 5%. Recanalization (TICI 2b-3) was selected more (32.9%) of 81%~90%. 90 d functional independent was selected more (33.8%) of 50%~60%. In 8.6% of centers, recanalization was less than 60%. In 24.3% of centers, hemorrhage was more than 10%. In 8.8% ofcenters, 90 d functional independent was less than 40%. The top three favorable training contents were strategy and management of emergency unexpected issues during operation, material selection and technical standard of emergency treatment, and prevention and management of complications. Conclusion The number of endovascular treatment of AIS is increasing in recent years. The 24 h multimodel imaging still needs improving. Hemorrhage complication, recanalization rate and functional independence also need improving. Standardized training and quality control are of key importance.

Key words: Acute ischemic stroke; Endovascular treatment; Standardized training; Quality control

执笔：霍晓川，高峰. 中国急性缺血性卒中血管内治疗现状初步调查[J]. 中国卒中杂志, 2016, 11(04): 283-287.

Acute Ischemic Stroke Corporation Group of Endovascular Treatment (HUO Xiao-Chuan, GAO Feng). Preliminary Investigation of Endovascular Treatment Status of Acute Ischemic Stroke in China[J]. Chinese Journal of Stroke, 2016, 11(04): 283-287.

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