急性前循环大血管闭塞性脑卒中高龄患者早期血管内治疗的安全性及有效性观察  

Safety and efficacy of early endovascular treatment in elderly IS patients due to large vessel acute anterior circulation occlusion

作　　者：汪文兵 杨倩[1] 黄显军[1] 许向军 袁莉莉 徐骏峰 许友清 葛良[1] 周志明[1] Wang Wenbing;Yang Qian;Huang Xianjun;Xu Xiangjun;Yuan Lili;Xu Junfeng;Xu Youqing;Ge Liang;Zhou Zhiming(Department of Neurology,Wannan Medical College Yijishan Hospital,Wuhu 241001,Anhui Province,China)

机构地区：[1]皖南医学院弋矶山医院神经内科

出　　处：《中华老年心脑血管病杂志》2019年第12期1236-1240,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金（81701061）

摘　　要：目的观察急性前循环大血管闭塞性脑卒中高龄患者早期血管内治疗的安全性及有效性。方法选择2014年12月~2019年2月在本中心行早期血管内治疗的急性前循环大血管闭塞性脑卒中患者198例,根据年龄分为高龄组(年龄≥80岁)35例和非高龄组(年龄<80岁)163例,回顾性分析收集2组患者的基线资料、围术期相关数据,用改良的Rankin量表(mRS)评分评价90 d预后,mRS评分≤2分为预后良好。结果高龄组年龄、高血压(88.6%vs 67.5%)、心房颤动(77.1%vs 51.5%)比例明显高于非高龄组,基线Alberta卒中项目早期CT评分[8.0(8.0,8.0)分vs 9.0(8.0,10.0)分]明显低于非高龄组,2组TOAST分型比较有统计学差异(P<0.05,P<0.01)。有效性指标中,高龄组与非高龄组血管成功再通和预后良好比例比较,差异无统计学意义(77.1%vs 81.0%,34.3%vs 46.0%,P>0.05),高龄组病死率明显高于非高龄组(42.9%vs 24.5%,P=0.028)。安全性指标中,高龄组与非高龄组术后颅内出血转化及出血性脑梗死型和脑实质内血肿型比例比较,差异无统计学意义(31.4%vs 23.3%,14.3%vs 14.1%,17.1%vs 9.2%,P>0.05)。高龄不是影响90 d患者死亡的独立危险因素(调整OR=1.368,95%CI:0.528~3.550,P=0.519)。结论急性前循环大血管闭塞性脑卒中高龄患者早期血管内治疗具有较高的有效性和安全性。Objective To study the safety and efficacy of early endovascular treatment in elderly ischemic stroke patients due to acute large vascular occlusion stroke(ALVOS).Methods One hundred and ninety-eight ischemic stroke patients due to ALVOS who underwent early endovascular treatment in our hospital from December 2014 to February 2019 were divided into≥80 years old group(n=35)and<80 years old group(n=163).Their baseline data and perioperative data were retrospectively analyzed.Their 90-d outcome was assessed according to their mRS score and judged as good when their mRS score was≤2.Results The age was significantly older,the incidence of hypertension and AF was significantly higher while Alberta Stroke Program Early CT(ASPECT)score was significantly lower in≥80 years old group than in<80 years old group(88.6%vs 67.5%,77.1%vs 51.5%,8.0 vs 9.0,P<0.05,P<0.01).No significant difference was detected in recanalization and good outcome between the two groups(77.1%vs 81.0%,34.3%vs 46.0%,P>0.05).The mortality was significantly higher in≥80 years old group than in<80 years old group(43%vs 24%,P=0.028).No significant difference was detected in the rate of postoperative intracranial hemorrhage transformation and types of hemorrhagic cerebral infaction and intraparenchymatous hematoma between the two groups(31.4%vs 23.3%,14.3%vs 14.1%,17.1%vs 9.2%,P>0.05).Advanced age was not an independent risk factor for the outcome of elderly ischemic stroke patients due to ALVOS after early endovascular treatment(adjusted OR=1.368,95%CI:0.528-3.550,P=0.519).Conclusion The safety and efficacy of early endovascular treatment are rather high in elderly ischemic stroke patients due to ALVOS after early endovascular treatment.

关 键 词：动脉闭塞性疾病 卒中 梗死 大脑中动脉 高血压 心房颤动 侧支循环 

分 类 号：R47[医药卫生—护理学]