急性脑梗死机械取栓后颅内出血转化的影响因素分析  

Analysis of influencing factors of intracranial hemorrhage transformation after mechanical thrombectomy in acute cerebral infarction

作　　者：许友清 沈海晨 詹凤丽[2] 张伟[3] XU You-qing;SHEN Hai-chen;ZHAN Feng-li;ZHANG Wei(Department of Neurology,yijishan hospital,Wannan Medical College,Wuhu Anhui 241000,China;Department of Urology,yijishan hospital,Wannan Medical College,Wuhu Anhui 241000,China;Department of Neurosurgery,ICU,Yijishan hospital,Wannan Medical College,Wuhu Anhui 241000,China)

机构地区：[1]皖南医学院弋矶山医院神经内科,安徽芜湖241000 [2]皖南医学院弋矶山医院泌尿外科,安徽芜湖241000 [3]皖南医学院弋矶山医院神经外科ICU,安徽芜湖241000

出　　处：《医药论坛杂志》2022年第11期37-40,45,共5页Journal of Medical Forum

基　　金：安徽省省级质量工程教学研究项目(2019jyxm106);皖南医学院弋矶山医院三新项目(Y20103,Y20100)。

摘　　要：目的探讨机械取栓术后急性脑梗死患者引发颅内出血转化的高危因素。方法收集2018年2月—2020年2月期间在皖南医学院弋矶山医院接受机械取栓术治疗的120例患者的相关临床资料,按照患者机械取栓后颅内出血发生情况分为颅内出血组(60例)、无颅内出血组(60例)。回顾分析分析患者相关临床资料,包含基本资料、疾病史、神经缺损评分、用药史等,同时通过Logistic回归模型分析导致患者机械取栓后出现颅内出血的相关危险因素。结果单变量分析结果显示,与无颅内出血组比较,颅内出血组年龄更大,伴有心血管基础疾病率、术前CT有低密度病灶率、术前重组组织型纤溶酶原激活剂(rtPA)溶栓率、取栓部位为前循环率均更高,梗死至血管再通时间更长,术前神经功能缺损(NIHSS)评分更高,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄(OR=2.582)、术前NIHSS评分(OR=2.951)、术前CT有低密度病灶(OR=3.184)、梗死至血管再通时间(OR=3.438)均是患者机械取栓后发生颅内出血的独立影响因素(P<0.05)。结论年龄大、NIHSS评分高、梗死至血管再通时间长、术前CT有低密度病灶均是导致急性脑梗死患者机械取栓后颅内出血发生的主要影响因素,临床需根据该类影响因素做好预防,才能降低患者引发颅内出血的风险性。Objective To explore the high risk factors of intracranial hemorrhage transformation(HT)in patients with acute cerebral infarction after mechanical thrombectomy.Methods The relevant clinical data of 120 patients who underwent mechanical thrombectomy treatment in our hospital from February 2018 to February 2020 were collected.According to the occurrence of intracranial hemorrhage after mechanical thrombectomy,the patients were divided into intracranial hemorrhage group(60 cases),none Intracranial hemorrhage group(60 cases).The relevant clinical data of the patients were analyzed retrospectively,including basic information,disease history,neurological deficit score,medication history,etc.At the same time,the Logistic regression model was used to analyze the risk factors of intracranial hemorrhage after mechanical thrombus removal.Results Univariate analysis results showed that compared with the group without intracranial hemorrhage,the intracranial hemorrhage group was older,accompanied by cardiovascular disease rate,preoperative CT with low-density lesion rate,preoperative rtPA thrombolysis rate,and thrombectomy site as the anterior circulation rate Both are higher,the time from infarction to recanalization is longer,and the preoperative NIHSS score is higher(P<0.05);Multivariate logistic regression analysis showed that age(OR=2.582),preoperative NIHSS score(OR=2.951),preoperative CT with low-density lesions(OR=3.184),and the time from infarction to recanalization(OR=3.438)were all It is an independent factor influencing the occurrence of intracranial hemorrhage after mechanical thrombus removal(P<0.05).Conclusion Old age,high NIHSS score,long time from infarction to vascular recanalization,and low-density lesions on preoperative CT are the main factors leading to the occurrence of intracranial hemorrhage after mechanical thrombus removal in patients with acute cerebral infarction.Clinical prevention should be based on such influencing factors in order to reduce the risk of intracranial hemorrhage in patients.

关 键 词：急性脑梗死 机械取栓 颅内出血转化 影响因素 神经功能缺损 

分 类 号：R743.3[医药卫生—神经病学与精神病学]