经以机械取栓为主的动脉内多模式治疗的大动脉闭塞性脑梗死患者短期预后的影响因素研究  

Influencing Factors Short-term Prognosis in Aortic Occlusive Cerebral Infarction Patients Treated by Mechanical Thrombectomy Leaded Intra-arterial Multimodal Therapy

作　　者：吕华东[1] 马可[1] 蓝瑞芳[1] LYU Hua-dong;MA Ke;LAN Rui-fang(Department of Neurology,the First People's Hospital of Qinzhou,Qinzhou 535000,China)

机构地区：[1]广西钦州市第一人民医院神经内科,535000

出　　处：《实用心脑肺血管病杂志》2018年第1期38-42,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探究经以机械取栓为主的动脉内多模式治疗的大动脉闭塞性脑梗死患者短期预后的影响因素。方法选取2014年5月—2016年5月在广西钦州市第一人民医院神经内科采用以机械取栓为主的动脉内多模式治疗的大动脉闭塞性脑梗死患者82例,根据术后3个月改良Rankin量表(mRS)评分分为预后良好组50例和预后不良组32例。比较两组患者一般资料、治疗情况及治疗结果,经以机械取栓为主的动脉内多模式治疗的大动脉闭塞性脑梗死患者短期预后的影响因素分析采用多因素Logistic回归分析。结果两组患者年龄、高血压发生率、心房颤动发生率比较,差异无统计学意义(P>0.05);两组患者性别、闭塞部位及糖尿病发生率比较,差异有统计学意义(P<0.05)。两组患者麻醉方式、取栓次数及行支架置入、行动脉溶栓、行静脉溶栓、行球囊扩张、术中应用替罗非班者所占比例比较,差异无统计学意义(P>0.05)。两组患者发病至穿刺时间、穿刺至血管开通时间比较,差异无统计学意义(P>0.05);预后良好组患者修正脑梗死溶栓(mTICI)分级、术前与术后24 h美国国立卫生研究院卒中量表(NIHSS)评分、术后24 h颅内出血发生率及血管再通率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,闭塞部位[OR=5.003,95%CI(1.809,13.836)]、糖尿病[OR=4.948,95%CI(1.950,12.554)]、mTICI分级[OR=0.234,95%CI(0.079,0.696)]、术前NIHSS评分[OR=3.536,95%CI(2.385,5.243)]、术后24 hNIHSS评分[OR=3.127,95%CI(2.184,4.476)]、术后24 h颅内出血[OR=3.801,95%CI(1.297,8.621)]、血管再通[OR=0.217,95%CI(0.070,0.672)]是经以机械取栓为主的动脉内多模式治疗的大动脉闭塞性脑梗死患者短期预后的影响因素(P<0.05)。结论闭塞部位、糖尿病、mTICI分级、术前NIHSS评分、术后24 hNIHSS评分、术后24 h颅内出血及血管再通是经以机械取栓为主的动脉内多模式治疗的大动脉�Objective To investigate the influencing factors short-term prognosis in aortic occlusive cerebral infarction patients treated by mechanical thrombectomy leaded intra-arterial multimodal therapy.Methods From May2014to May2016,a total of82aortic occlusive cerebral infarction patients treated by mechanical thrombectomy leaded intra-arterial multimodal therapy were selected in the Department of Neurology,the First People's Hospital of Qinzhou.According to mRS score3months after surgery,all of the82patients were divided into A group(with good prognosis,n=50)and B group(with poor prognosis,n=32);general information,therapeutic condition and treatment outcome were compared between the two groups,and multivariate Logistic regression analysis was used to analyze the influencing factors short-term prognosis in aortic occlusive cerebral infarction patients treated by mechanical thrombectomy leaded intra-arterial multimodal therapy.Results No statistically significant differences age,incidence of hypertension or atrial fibrillation was found between the two groups(P>0.05),while there were statistically significant differences of gender,occlusive locations and incidence of diabetes between the two groups(P<0.05).No statistically significant differences of anesthesia methods,thrombus extraction times,proportion of patients undergoing stent implantation,intra-arterial thrombolysis,intravenous thrombolysis,balloon dilatation or using tirofiban during surgery was found between the two groups(P>0.05).No statistically significant differences of duration between attack and puncture or duration between puncture and vascular recanalization was found between the two groups(P>0.05),while there were statistically significant differences of mTICI grading,NIHSS score before surgery and24hours after surgery,incidence of intracranial hemorrhage24hours after surgery and vascular recanalization rate between the two groups(P<0.05).Multivariate Logistic regression analysis results showed that,occlusive locations〔OR=5.003,95%CI(1.809,13.836)�

关 键 词：脑梗死 大动脉闭塞 机械取栓 预后 影响因素分析 

分 类 号：R743.33[医药卫生—神经病学与精神病学]