机械取栓治疗前循环急性大血管闭塞性脑梗死的疗效及血管再通者预后不良的影响因素  

Curative effect of mechanical thrombectomy in the treatment of anterior circulation acute large vessel occlusion cerebral infarction and the influencing factors for poor prognosis in patients with vascular recanalization

作　　者：李玲[1] 丁鸭锁[1] 左鹏 范琳 LI Ling;DING Yasuo;ZUO Peng;FAN Lin(Taizhou People’s Hospital Affiliated to Nanjing Medical University,Taizhou 225399,China;不详)

机构地区：[1]南京医科大学附属泰州人民医院,江苏泰州225399

出　　处：《中国实用神经疾病杂志》2023年第5期605-609,共5页Chinese Journal of Practical Nervous Diseases

基　　金：江苏省卫生健康委科研项目(编号:M2020047)。

摘　　要：目的探讨机械取栓治疗前循环急性大血管闭塞性脑梗死的疗效及血管再通患者预后不良的影响因素。方法选取2019-01—2022-4在南京医科大学附属泰州人民医院接受治疗的前循环急性大血管闭塞性脑梗死患者156例,术后根据脑梗死溶栓分级(TICI)评分标准评估所有患者的血管再通率,统计术后症状性脑出血的发生情况。所有血管再通患者术后均进行90 d随访,根据改良的Rankin(mRS)评分分为预后不良组和预后良好组。采用多因素Logistic回归分析血管再通患者预后不良的影响因素。结果156例前循环急性大血管闭塞性脑梗死患者经机械取栓治疗后有142例TICI评分≥2b,血管再通率为91.03%,14例发生症状性脑出血,发生率为8.97%。142例血管再通患者90 d时预后良好68例,预后不良74例,预后不良率为52.11%。预后不良组的年龄[(61.12±12.65)岁vs(56.89±10.98)岁]明显大于预后良好组(P<0.05)。预后不良组的入院美国国立卫生研究院卒中量表(NIHSS)评分[(19.65±5.12)分vs(16.82±4.83)分]、发病至入院时间[(243.69±70.32)min vs(220.54±60.84)min]、发病至血管再通时间[(339.48±68.64)min vs(310.45±65.33)min]、取栓次数[(1.86±0.45)次vs(1.44±0.38)次]均大于预后良好组,应用替罗非班比例[5.41%vs 16.18%]小于预后良好组(P<0.05)。年龄、入院NIHSS评分、发病至血管再通时间、取栓次数均是血管再通患者预后不良的危险因素(P<0.05)。结论机械取栓治疗前循环急性大血管闭塞性脑梗死有较高的血管再通率,年龄、入院NIHSS评分、发病至血管再通时间、取栓次数均是血管再通患者预后不良的危险因素。Objective To investigate the curative effect of mechanical thrombectomy in the treatment of acute large vessel occlusion cerebral infarction in anterior circulation and the influencing factors for poor prognosis in patients with vascular recanalization.Methods Totally 156 patients with acute large vessel occlusive cerebral infarction in the anterior circulation who were treated in Taizhou People’s Hospital Affiliated to Nanjing Medical University from January 2019 to April 2022 were selected.The vascular recanalization rate of all patients was evaluated according to the thrombolytic classification of cerebral infarction(TICI)score standard after opera⁃tion,and the incidence of symptomatic cerebral hemorrhage after operation was counted.All patients with vascular recanalization were followed up for 90 days,and were divided into poor prognosis group and good prognosis group according to the modified Rankin(mRS)score.Multivariate logistic regression was used to analyze the influencing factors of poor prognosis in patients with vascular recanalization.Results After mechanical throm⁃bectomy,142 of 156 patients with acute large vessel occlusion cerebral infarction in the anterior circulation had a TICI score of≥2b,and the vascular recanalization rate was 91.03%.Fourteen patients had symptomatic cerebral hemorrhage(8.97%).The prognosis of 142 patients with vascular recanalization was good in 68 cases and bad in 74 cases at 90 days,with a poor prognosis rate of 52.11%.The age of poor prognosis group[(61.12±12.65)years vs(56.89±10.98)years]was significantly older than that of good prognosis group(P<0.05).The National Insti⁃tute of Health stroke scale(NIHSS)score[(19.65±5.12)points vs(16.82±4.83)points],the time from onset to admission[(243.69±70.32)min vs(220.54±60.84)min],the time from onset to vascular recanalization[(339.48±68.64)min vs(310.45±65.33)min],and the number of thrombus removal[(1.86±0.45)times vs(1.44±0.38)times]in the poor prognosis group were higher than those in the good prognosis gro

关 键 词：脑梗死 大血管闭塞性 机械取栓 影响因素 预后不良 

分 类 号：R743.33[医药卫生—神经病学与精神病学]