急性缺血性脑卒中机械取栓后大面积脑梗死发生及其影响因素分析  

The occurrence of large hemispheric infarction after endovascular thrombectomy for acute ischemic stroke and its influencing factors: a clinical analysis

作　　者：邱凯 施海彬[1] 祖庆泉[1] 刘圣[1] 赵林波[1] 贾振宇[1] 曹月洲[1] 周春高[1] QIU Kai;SHI Haibin;ZU Qingquan;LIU Sheng;ZHAO Linbo;JIA Zhenyu;CAO Yuezhou;ZHOU Chungao(Department of Interventional Radiology,First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,210029

出　　处：《介入放射学杂志》2020年第12期1182-1186,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金青年科学基金(81501565);国家自然科学基金面上项目(81571777)。

摘　　要：目的探讨前循环急性缺血性脑卒中(AIS)患者机械取栓后大面积脑梗死(LHI)发生及其影响因素。方法回顾性分析2015年1月至2018年12月于南京医科大学第一附属医院接受机械取栓治疗的前循环AIS患者临床资料。主要观察指标是术后5~7 d LHI,即头颅影像学检查所示梗死面积大于大脑中动脉供血区1/3。采用单因素和多因素logistic回归分析明确LHI发生相关因素,并分析LHI与90 d改良Rankin量表(mRS)评分相关性。结果共计纳入227例患者。其中107例(47.1%)术后发生LHI。单因素和多因素logistic回归分析显示,基线高美国国立卫生研究院卒中量表(NIHSS)评分、低Alberta卒中项目早期CT评分(ASPECTS)、侧支代偿差及再灌注欠佳是LHI发生的独立危险因素(P<0.05)。与非LHI组相比,LHI组患者90 d良好预后率更低(17.8%对72.5%,χ^(2)=68.102,P<0.001)。结论基线高NIHSS评分、低ASPECTS、侧支代偿差及再灌注欠佳是LHI发生的独立危险因素。LHI发生与临床预后不佳相关。Objective To discuss the occurrence and risk factors of large hemispheric infarction(LHI) after endovascular thrombectomy(EVT) for acute ischemic stroke(AIS). Methods The clinical data of patients with anterior circulation AIS, who were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive EVT during the period from January 2015 to December 2018, were retrospectively analyzed. The main observation indicator was the occurrence of LHI within 5-7 days after EVT.LHI was defined as such a criterion that the infarction area displayed on head imaging examination was larger than one third of the middle cerebral artery territory. By using univariate and multivariate logistic regression analyses, the factors associated with LHI occurrence were evaluated, and the correlation between LHI and 90-day modified Rankle Scale(mRS) score was analyzed. Results A total of 227 patients were enrolled in this study.The patients were divided into LHI group(n=107) and non-LHI group(n=120). Univariate and multivariate logistic regression analyses showed that baseline index values which were higher than National Institute of Health Stroke Scale(NIHSS) scores, CT baseline index values which were lower than Alberta Stroke Program Early Computed Tomography scores(ASPECTS), poor compensatory collateral circulation and poor blood reperfusion were independent risk factors for LHI(P<0.05). The 90-day good prognosis rate in LHI group was 17.8%, which was lower than 72.5% in non-LHI group (χ^(2)=68.102. P<0.001). Conclusion High baseline NIHSS score, low ASPECTS, poor compensatory collateral circulation and poor blood reperfusion are independent risk factors for the occurrence of LHI after EVT. The occurrence of LHI is closely related to poor clinical prognosis.

关 键 词：急性缺血性脑卒中 大面积脑梗死 机械取栓 影响因素 临床预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]