急性前循环大血管闭塞性缺血性脑卒中取栓治疗“首通效应”的影响因素分析  

Analysis of the factors affecting the “first pass effect” of thrombectomy in the treatment of acute anterior circulation macrovascular occlusive ischemic stroke

作　　者：李雷 田甜[1] 杜佳 褚会松 张继伟[1] 于淼[1] 马志君[1] 呼铁民[1] Li Lei;Tian Tian;Du Jia(Department of Neurosurgery,Affiliated Hospital of Chengde Medical College,Chengde Hebei 067000)

机构地区：[1]河北省承德医学院附属医院神经外科,067000

出　　处：《卒中与神经疾病》2022年第3期210-214,共5页Stroke and Nervous Diseases

摘　　要：目的 探讨影响前循环大血管闭塞性缺血性脑卒中患者取栓治疗“首通效应”的因素。方法 回顾性分析2018年1月-2021年3月就诊于河北承德医学院附属医院神经外科急性前循环大血管闭塞性缺血性脑卒中并行支架取栓成功患者58例,依据取栓次数将其分为首次再通组及多次再通组,通过对2组患者的基线资料(糖尿病史、吸烟史、饮酒史、年龄及男性等)、入院时美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分、入院时收缩压/舒张压、入院时阿尔伯塔卒中项目早期CT评分(Alberta stroke program early CT scores,ASPECTS)、取出栓子病理分析等资料进行比较,并采用Logistic回归分析影响“首通效应”的独立影响因素;发病90 d后用改良Rankin量表(Modified Rankin scale,MRS)评分评价预后。结果 在纳入的58例患者中首次再通组患者发病90 d后的临床预后明显好于多次再通组患者;Logistic回归分析显示,闭塞部位、血栓类型、入院时ASPECTS评分为首通效应的独立影响因素(P<0.05)。结论 大脑中动脉M1段(M1 segment of middle cerebral artery,MCA-M1)闭塞、栓子为红色血栓、入院时高ASPECTS评分是首通效应的独立影响因素。Objective To study the factors affecting the“first pass effect”of thrombectomy Based on the analysis of the data of patients with anterior circulation macrovascular occlusive ischemic stroke.Methods A total of 58 patients with anterior circulation macrovascular occlusive ischemic stroke and stent thrombectomy in the affiliated Hospital of Hebei Chengde Medical College from January 2018 to March 2021 were analyzed retrospectively.According to the times of thrombectomy,they were divided into first recanalization group and multiple recanalization group.Through the comparative analysis of the baseline data(diabetes history,smoking history,drinking history,age and sex,etc.),NIHSS score at admission,systolic blood pressure/diastolic blood pressure at admission,ASPECTS score at admission,pathological analysis results of embolus removal,Evaluation of prognosis by modified Rankin scale(MRS) score in 90 days,Logistic regression analysis was used to analyze the independent influencing factors of "first pass effect".Results Among the 58 patients included,the 90-day clinical prognosis of the first recanalization group was significantly better than that of the multiple recanalization group.Logistic regression analysis showed that the location of occlusion,the type of thrombus and ASPECTS score at admission were the independent factors affecting the first pass effect.Conclusion MCA-M1 segment occlusion,red thrombus and high ASPECTS score at admission were independent factors affecting the first pass effect.

关 键 词：机械取栓 急性缺血性脑卒中 首通效应 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]