术前毛细血管指数评分评估前循环大血管闭塞取栓术患者预后的应用价值  

Application value of preoperative Capillary Index Score in evaluating the prognosis of patients undergoing thrombectomy for anterior circulation large vessel occlusion

作　　者：杨明昊 唐建勋 胡利刚 姚小琼 蔡黄权 唐景峰 YANG Ming-hao;TANG Jian-xun;HU Li-gang(Department of Cerebrovascular Disease(Department of Stroke),the Second Affiliated Hospital of Guilin Medical University,Guangxi 541199,China)

机构地区：[1]桂林医学院第二附属医院脑血管病科(脑卒中科),广西541199

出　　处：《中国临床新医学》2023年第1期77-82,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西高校中青年教师科研基础能力提升项目(编号:2019KY0544)。

摘　　要：目的探讨毛细血管指数评分(CIS)评估前循环大血管闭塞(LVO)取栓术患者预后的应用价值。方法选择2016年1月至2021年7月桂林医学院第二附属医院收治并接受机械取栓术的106例急性前循环LVO患者的临床资料。根据术前脑血管造影资料计算CIS,其中CIS不良(pCIS)44例(CIS 0~1分,pCIS组),CIS良好(fCIS)62例(CIS 2~3分,fCIS组)。分析患者机械取栓术后90 d预后不良[改良Rankin量表(mRS)评分>2分]及发生恶性脑水肿的危险因素。结果与fCIS组比较,pCIS组合并高血压、冠心病的人数比例更小,阿尔伯塔卒中项目早期CT评分(ASPECTS)更低,入院时美国国立卫生研究院卒中量表(NIHSS)评分更高,术中采取补救措施的人数比例更大,术后恶性脑水肿发生率以及术后90 d预后不良率和病死率均更高,差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,入院时NIHSS评分高[OR(95%CI)=1.214(1.102,1.338)]和pCIS[OR(95%CI)=4.924(1.780,13.620)]是患者机械取栓术后90 d预后不良的危险因素(P<0.05);pCIS[OR(95%CI)=21.670(6.593,71.226)]、改良脑梗死溶栓(mTICI)分级为0~2a级[OR(95%CI)=50.334(3.865,655.525)]以及发病至血管再通时间(TIR)>4.5 h[OR(95%CI)=5.557(1.392,22.180)]是患者术后发生恶性脑水肿的危险因素(P<0.05)。结论pCIS的前循环LVO患者机械取栓术后预后不佳,恶性脑水肿发生率高,应慎重考虑行机械取栓术。Objective To investigate the application value of preoperative Capillary Index Score(CIS)in evaluating the prognosis of patients undergoing thrombectomy for anterior circulation large vessel occlusion(LVO).MethodsThe clinical data of 106 patients with acute anterior circulation LVO who were admitted to the Second Affiliated Hospital of Guilin Medical University and underwent mechanical thrombectomy from January 2016 to July 2021 were selected.CIS was calculated according to the preoperative cerebral angiography data,including 44 cases of poor CIS(pCIS,CIS:0-1 points,pCIS group)and 62 cases of favorable CIS(fCIS,CIS:2-3 points,fCIS group).The patients with poor prognosis[modified Rankin Scale(mRS)score>2 points]and the risk factors of malignant cerebral edema 90 days after mechanical thrombectomy were analyzed.Results Compared with the fCIS group,the pCIS group had a smaller proportion of patients with hypertension and coronary heart disease,lower Alberta Stroke Program Early CT Score(ASPECTS),and higher National Institute of Health Stroke Scale(NIHSS)score at admission,greater proportion of patients on whom remedial measures were taken during the operation,higher incidence of postoperative malignant cerebral edema,and higher rate of poor prognosis and mortality 90 days after surgery,and the differences were statistically significant(P<0.05).The results of binary logistic regression analysis showed that high NIHSS score at admission[OR(95%CI)=1.214(1.102,1.338)]and pCIS[OR(95%CI)=4.924(1.780,13.620)]were the risk factors for poor prognosis 90 days after mechanical thrombectomy(P<0.05).pCIS[OR(95%CI)=21.670(6.593,71.226)],modified thrombolysis in cerebral infarction(mTICI)grade 0~2a[OR(95%CI)=50.334(3.865,655.525)]and time from ictus to revascularization(TIR)>4.5 h[OR(95%CI)=5.557(1.392,22.180)]were the risk factors for postoperative malignant cerebral edema(P<0.05).Conclusion Anterior circulation LVO patients with pCIS have a poor prognosis and a high incidence of malignant cerebral edema.Therefore,mechanical thro

关 键 词：毛细血管指数评分 卒中 前循环大血管闭塞 机械取栓术 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]