高龄急性前循环脑梗死患者支架取栓术预后分析  

Analysis of prognosis after stent thrombectomy in elderly patients with acute anterior circulation stroke

作　　者：胡玉奇 贾琦 代林志[1] 许晖[1] 李阳 陈富雷 赵冬[1] HU Yuqi;JIA Qi;DAI Linzhi;XU Hui;LI Yang;CHEN Fulei;ZHAO Dong(Department of Neurosurgery,First affiliated Hospital of Shihezi University,Shihezi,832000)

机构地区：[1]石河子大学医学院第一附属医院,新疆石河子832000

出　　处：《中国实用神经疾病杂志》2022年第6期699-704,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:81960222);兵团中青年科技创新领军人才(编号:2020CB011)。

摘　　要：目的探讨80岁及以上急性前循环脑梗死患者行支架取栓术预后的影响因素。方法回顾性研究石河子大学医学院第一附属医院2018-01—2021-07收治的27例80岁及以上前循环大动脉闭塞型脑梗死急诊支架取栓患者的临床资料,对比患者术后改良Rankin量表评分(mRS)对可能影响预后因素进行统计学分析。结果27例急性前循环脑梗死患者中,中位年龄82岁;其中14例(51.9%)为大脑中动脉闭塞,13例(48.1%)为颈内动脉闭塞;基线NIHSS评分中位数为20分;术后NIHSS评分中位数为15分;术后即刻造影显示25例(92.6%)再通成功;8例(29.7%)发生出血性转化;90 d良好结局(mRS 0~3)11例(40.7%),90 d不良结局(mRS 4~6)16例(59.3%),死亡10例(37%);术后并发肺部感染者17例(63.0%)。预后良好组与预后不良组基线NIHSS评分(15分vs 20分,P<0.05)、术后NIHSS评分(6分vs 18分,P<0.001)、卒中后肺部感染率(2%vs 15%,P<0.001)比较差异均有统计学意义。结论对于80岁及以上前循环大动脉闭塞型脑梗死患者,支架取栓是可行的治疗方法,但应严格评估患者NIHSS评分及加强术后呼吸道管理。Objective To investigate the factors of prognosis in patients with acute anterior circulation stroke aged 80 years and above.Methods We retrospectively studied the clinical data of 27 patients with acute anterior circulation cerebral infarction aged 80 years and above in our department from January of 2018 to July of 2021,the postoperative modified Rankin scale score(modifiedRankinscale,mRS)was compared to analyze the possible prognostic factors.Results Among the 27 patients with acute anterior circulation cerebral infarction,the median age was 82 years old,including 14 cases(51.9%)with middle cerebral artery occlusion and 13 cases(48.1%)with internal carotid artery occlusion.The median baseline NIHSS score was 20;the median postopera⁃tive NIHSS score was 15;immediate postoperative angiography showed successful recanalization in 25 cases(92.6%)and hemorrhagic transformation in 8 cases(29.7%).11 patients(40.7%)had a 90-day good outcome(mRS 0~3),16 patients(59.3%)had a 90-day adverse outcome(mRS4~6),of which 10 patients(37%)died,and 17 patients(63.0%)were complicated with pulmonary infection after operation.There were significant differences in baseline NIHSS score(15 vs 20,P<0.05),postoperative NIHSS score(6 vs 18,P<0.001)and pul⁃monary infection after stroke(2%vs 15%,P<0.001)between good prognosis group and poor prognosis group.Conclusion Stent thrombectomy is an effective treatment of patients with acute anterior circulation stroke aged 80 years and above,but the NIHSS score of the patients should be strictly evaluated and postoperative respiratory tract management should be strengthened.

关 键 词：脑梗死 前循环 支架取栓 高龄 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]