高龄前循环急性大血管闭塞性脑卒中患者机械取栓的临床预后观察  

Clinical efficacy of mechanical thrombectomy in advanced age patients with acute anterior circulation large vessel occlusive stroke

作　　者：朱玉娟[1] 纪亚晨 徐昕 徐骏峰 许向军 杨科 许友清 杨倩[1] 黄显军[1] 周志明[1] Zhu Yujuan;Ji Yachen;Xu Xin;Xu Junfeng;Xu Xiangjun;Yang Ke;Xu Youqing;Yang Qian;Huang Xianjun;Zhou Zhiming(Department of Neurology,Yijishan Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院神经内科,芜湖241001

出　　处：《中华神经医学杂志》2022年第3期263-272,共10页Chinese Journal of Neuromedicine

基　　金：皖南医学院中青年科研基金项目(WK2019F22)。

摘　　要：目的评估高龄前循环急性大血管闭塞性脑卒中(ALVOS)患者机械取栓的收益及风险,并探讨影响该类患者预后的相关因素。方法序贯性地收集国内3家高级卒中中心自2014年1月至2020年12月收治的680例行机械取栓的前循环ALVOS患者进行研究。(1)根据年龄将患者分为高龄组(≥80岁)与非高龄组(<80岁),比较2组患者间术后血管成功再通率、围手术期并发症发生率、90 d预后良好率[改良Rankin量表(mRS)评分≤2分]及病死率的差异。(2)根据90 d预后情况将患者分为预后良好组(mRS评分≤2分)与预后不良组(mRS评分>2分),采用单因素分析及多因素Logistic回归分析探讨影响患者机械取栓预后的独立因素。(3)根据90 d预后情况将高龄组患者分为预后良好亚组(mRS评分≤2分)与预后不良亚组(mRS评分>2分),采用单因素分析及多因素Logistic回归分析探讨影响高龄患者机械取栓预后的独立因素。结果(1)680例患者中高龄组92例(13.5%),非高龄组588例(86.5%)。高龄组患者的术后血管成功再通率(67.4%)明显低于非高龄组(77.9%),90 d预后良好率(20.7%)明显低于非高龄组(50.2%),90 d病死率(40.2%)明显高于非高龄组(21.1%),差异均有统计学意义(P<0.05);2组患者间术后症状性颅内出血发生率(15.6%vs.10.6%)及恶性脑水肿发生率(12.2%vs.17.6%)的差异均无统计学意义(P>0.05)。进一步对高龄组与非高龄组患者的基线资料进行倾向性评分匹配(1∶1)后统计分析显示,91例高龄组患者的90 d预后良好率(20.9%)明显低于91例非高龄组(36.3%),恶性脑水肿发生率(12.4%)明显低于非高龄组(33.3%),差异均有统计学意义(P<0.05);2组间术后血管成功再通率(67.0%vs.71.4%)、症状性颅内出血发生率(15.7%vs.17.6%)及90 d病死率(39.6%vs.37.4%)的差异均无统计学意义(P>0.05)。(2)680例患者中预后良好组314例(46.2%),预后不良组366例(53.8%)。单因素分析显示,与预后良好组比较,预后不良�Objective To evaluate the benefits and risks of advanced age patients with acute anterior circulation large vessel occlusive stroke(ALVOS)accepted mechanical thrombectomy(MT),and explore the related influencing factors for prognoses in these patients.Methods Six hundred and eighty patients with acute anterior circulation ALVOS accepted MT in 3 comprehensive stroke centers from January 2014 to December 2020 were sequentially collected.(1)Patients were divided into advanced age group(≥80 years old)and non-advanced age group(<80 years old)according to age,and the differences between the two groups were compared in successful postoperative vascular recanalization rate,incidence of perioperative complications,and good prognosis rate(modified Rankin scale[mRS]scores≤2)and mortality 90 d after onset.(2)Patients were divided into good prognosis group(mRS scores≤2)and poor prognosis group(mRS scores>2)according to the prognoses 90 d after onset;univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the patients after MT.(3)According to the prognoses 90 d after onset,the advanced age patients were divided into good prognosis subgroup(mRS scores≤2)and poor prognosis subgroup(mRS scores>2).Univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the elderly patients after MT.Results(1)In these 680 patients,92 patients(13.5%)were into the advanced age group and 588 patients(86.5%)were in the non-advanced age group;patients in the advanced age group had significantly lower successful recanalization rate(67.4%vs.77.9%),significantly lower good prognosis rate 90 d after onset(20.7%vs.50.2%),and statically higher mortality 90 d after onset(40.2%vs.21.1%)as compared with the non-advanced age group(P<0.05);however,there was no significant difference between the two groups in the incidences of symptomatic intracranial hemorrhage(sICH,15.6%vs.10.6%)and malignant cerebral edema

关 键 词：急性大血管闭塞性脑卒中 前循环 高龄 机械取栓 预后 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]