急性缺血性脑卒中血管再通治疗后的影响因素  

Influencing factors after vascular recanalization in acute ischemic stroke

作　　者：汤定中 胡灿芳 张磊[1] 罗国君[1] 刘振 TANG Ding-zhong;HU Can-fang;ZHANG Lei;LUO Guo-jun;LIU Zhen(Department of Neurology,Jinshan Branch of Shanghai the Sixth People’s Hospital,Shanghai 201599,China)

机构地区：[1]上海市第六人民医院金山分院神经内科,上海201599

出　　处：《医药论坛杂志》2022年第23期33-37,共5页Journal of Medical Forum

基　　金：上海市金山区科学技术委员会科研课题(2019-3-12);上海市卫生健康委员会科研课题(201940262)。

摘　　要：目的探讨急性缺血性脑卒中(acute ischemic stroke,AIS)血管再通治疗预后的影响因素。方法选取在上海市第六人民医院金山分院接受血管再通治疗的AIS患者124例,根据治疗预后分为预后良好组(76例)与预后不良组(48例),比较两组血管开通治疗相关指标、治疗前与治疗后24 h NIHSS指标、血清Netrin-1、陷窝蛋白1(Cav-1)水平以及术后并发症情况。结果预后良好组男性患者比例(61.84%)低于预后不良组(68.75%),年龄(63.48±9.66)岁低于预后不良组(74.26±10.81)岁(P<0.05);预后良好组血管再通治疗时间(63.83±14.24)min短于预后不良组(87.73±18.65)min,有创机械通气率(8.21%)低于预后不良组(70.83%),血管再通率(73.68%)高于预后不良组(60.53%)(P<0.05);预后良好组治疗前NIHSS评分(14.24±4.64)分、治疗后24 h NIHSS评分(15.37±5.34)分、NIHSS变化值(1.13±0.77)分、Cav-1(16.27±4.32)μg/L分别低于预后不良组(19.16±5.22)分、(23.72±7.28)分、(5.56±2.28)分、(27.82±4.69)μg/L(P<0.05)。两组患者Netrin-1表达水平对比差异无统计学意义(P>0.05)。预后良好组出血转化率(22.37%)、肺炎发生率(59.21%)、严重脑水肿发生率(18.42%)低于预后不良组(43.42%、83.33%、62.5%)(P<0.05);患者年龄(OR=3.522)、有创机械通气(OR=3.831)、严重脑水肿(OR=3.483)、治疗后NIHSS评分(OR=4.963)、Cav-1(OR=3.184)是影响患者预后的危险因素(P<0.05)。结论AIS血管再通治疗预后受患者年龄、有创机械通气、严重脑水肿等多种影响因素影响,NIHSS、Cav-1可作为评估预后参考指标,血清Netrin-1蛋白表达水平与AIS患者再通治疗的预后无明显联系。Objective To investigate the factors influencing the prognosis of acute ischemic stroke(AIS)after vascular recanalization.Methods Totally 124 AIS patients who received vascular recanalization therapy in our hospital were selected and divided into good prognosis group(48 cases)and poor prognosis group(76 cases)according to the treatment prognosis.The general information,vascular opening treatment related indicators,NIHSS indicators before and after treatment 24 hours,levels of Netrin-1 and cav-1(CAV-1)and postoperative complications were compared.Serum were determined by ELISA.Results The proportion of male patients in the good prognosis group(61.84%)was lower than that in the poor prognosis group(68.75%),and the age(63.48±9.66)was lower than that in the poor prognosis group(74.26±10.81)(P<0.05).The duration of vascular recanalization in the good prognosis group(63.83±14.24)min was shorter than that in the poor prognosis group(87.73±18.65)min,the rate of invasive mechanical ventilation(8.21%)was lower than that in the poor prognosis group(70.83%),and the rate of vascular recanalization(73.68%)was higher than that in the poor prognosis group(60.53%)(P<0.05).Good prognosis group NIHSS score before treatment(14.24±4.64),24hNIHSS score after treatment(15.37±5.34),NIHSS change value(1.13±0.77),caV-1(16.27±4.32)μg/L was lower than that of the poor prognosis group[(19.16±5.22),(23.72±7.28),(5.56±2.28),(27.82±4.69)μg/L](P<0.05).There was no significant difference in netrin-1 expression between 2 groups(P>0.05).The bleeding conversion rate(22.37%),incidence of pneumonia(59.21%)and incidence of severe cerebral edema(18.42%)in good prognosis group were lower than those in poor prognosis group(43.42%,83.33%,62.5%)(P<0.05).Patients’age(OR=3.522),invasive mechanical ventilation(OR=3.831),severe cerebral edema(OR=3.483),NIHSS score after treatment(OR=4.963),Netrin-1(OR=3.338),cav-1(OR=3.184)were risk factors affecting the prognosis of patients(P<0.05).Conclusion The prognosis of AIS recanalization treatment is af

关 键 词：缺血性脑卒中 血管再通 预后 NETRIN-1 陷窝蛋白1 

分 类 号：R743.3[医药卫生—神经病学与精神病学]