全脑血管造影未见血管阻塞的急性脑梗死患者的临床预后  

Clinical Outcome of Acute Ischemic Stroke Patients Without Visible Arterial Occlusion on Digital Subtraction Angiogram

作　　者：刘新通[1,2,3] 王伟[1] 唐洲平[1] 曾文高[1] 何池忠[2,3] 王丽娟[2,3] 卢海克[2,3] 李昌茂[2,3] 张雄[2,3] 王硕[2,3] 代成波[2,3] 马桂贤[2,3] 杨哲贤[2,3] 马腾云[2,3] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经科,武汉430030 [2]广东省人民医院神经科,广州510080 [3]广东省医学科学院神经病学研究所,广州510080

出　　处：《神经损伤与功能重建》2010年第5期347-351,共5页Neural Injury and Functional Reconstruction

摘　　要：目的:探讨起病1周内全脑血管造影(DSA)未见血管阻塞的急性脑梗死患者的临床预后。方法:急性脑梗死患者260例,在发病1周内完成全脑血管DSA和头颅CT、MRI检查,采用NI HSS量表评估入院时病情,改良Rankin量表(mRS)评估患者3个月时的预后,mRS≤2分视为预后良好,并对影响患者预后的危险因素进行多因素logistic回归分析。结果:260例患者中,发病1周内全脑血管DSA正常者96例(37%),其中头颅MRI显示有相应梗死灶93例(97%),发病1周内脑血管自然再通率为18%(46/260)。脑血管DSA未见血管阻塞的患者3个月时预后良好者67例(70%)。多因素logistic回归分析显示,入院时NI HSS评分[OR=0.231(0.080～0.811),P=0.013]、是否为大面积脑梗死[OR=0.171(0.062～0.725),P=0.006]显著影响患者3个月时的预后。结论:起病1周内急性脑梗死患者血管的再通率为18%,DSA检查显示无血管阻塞的患者为37%,其中70%的患者预后良好,入院时的病情及脑梗死面积是影响患者3个月预后的主要因素。Objective： To delineate the clinical outcome of acute ischemic stroke patients without visible arterial occlusion on digital subtraction angiograms（DSA） within one week of stroke onset.Methods： 260 patients with acute ischemic stroke were examined by DSA,brain CT and MRI scanning within one week after stroke.On admission National Institutes of Health Stroke Scale（NIHSS） scores and on discharge modified Rankin Scores（mRS） were assessed.Good outcome was defined as a mRS score less than 2.Multivariate logistic regression analysis was used to evaluate the relationship between stroke risk factors and clinical outcome of patients.Results： In the 260 patients,no arterial occlusion was observed in 96（37%） patients.The spontaneous recanalization rate was 18%.About 70%（67/96） of the patients had a favorable clinical outcome 3 months afterwards.Multivariate logistic regression analysis showed that the admission NIHSS scores [OR=0.231（0.080～0.811）,P=0.013] and the size of cerebral infarction [OR=0.171（0.062～0.725）,P=0.006] were stroke risk factors which significantly affected 3-month outcome in patients.Conclusion： The spontaneous recanalization rate was 18%.Approximately 70% patients with ischemic stroke without arterial occlusion on DSA（within 1 week onset） have a favorable clinical outcome and the outcome at 3 months were affected by the admission NIHSS scores and the size of cerebral infarction.

关 键 词：缺血性脑卒中 脑血管造影 预后 

分 类 号：R741[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]