老年后循环梗死患者血管内治疗短期预后的影响因素分析  

AN ANALYSIS OF INFLUENCING FACTORS FOR SHORT-TERM PROGNOSIS AFTER ENDOVASCULAR TREATMENT IN ELDERLY PATIENTS WITH POSTERIOR CIRCULATION INFARCTION

作　　者：曹茄艳 刘信东 吴小林 冯琼 刘漫 CAO Qieyan;LIU Xindong;WU Xiaolin;FENG Qiong;LIU Man(Department of Endocrinology,416 Hospital of Nuclear Industry,Chengdu 610051,China)

机构地区：[1]成都医学院附属第二医院,核工业四一六医院内分泌科,四川成都610051 [2]成都医学院附属第二医院,核工业四一六医院神经内科,四川成都610051 [3]成都医学院附属第二医院,核工业四一六医院肿瘤科,四川成都610051

出　　处：《精准医学杂志》2023年第5期465-468,共4页Journal of Precision Medicine

基　　金：四川省医学会高血压疾病专项基金(2019TG23)。

摘　　要：目的探讨老年后循环梗死患者血管内治疗短期预后的影响因素。方法回顾性分析2019年1月—2020年12月于核工业四一六医院进行血管内治疗的50例老年后循环梗死患者的临床资料,包括术前患者的年龄、性别、吸烟史、饮酒史等一般情况,糖尿病、高血压、高尿酸血症、短暂性脑缺血发作等既往疾病史,发病至入院时间(ODT)、就诊至治疗时间(DNT)、入院时NIHSS评分等发病后观察指标,术后即刻NIHSS评分、血管再通情况、术后并发症等术后情况,依据术后90 d改良Rankin量表(mRS)评分分为预后良好组和预后不良组,分析两组上述指标的差异,并采用多因素logistic回归分析患者血管内治疗短期预后影响因素。结果预后良好组和预后不良组患者分别为20例和30例,两组患者的收缩压、糖化血红蛋白(HbA1c)、血尿酸、总胆固醇(TC)水平及术后改良脑梗死溶栓(mTICI)分级、术前及术后即刻NIHSS评分、ODT以及术后卒中相关性肺炎等9项指标差异有显著统计学意义(t=2.30~4.13,χ^(2)=6.35、7.07,P<0.05)。多因素logistic回归分析结果显示,HbA1c≥6.5%、血尿酸≥420 mmol/L(男)或者360 mmol/L(女)、术后mTICI分级(血管未通)、术后即刻NIHSS评分≥10分是影响患者血管内治疗短期预后的危险因素(P<0.05)。结论HbA1c、血尿酸、术后mTICI分级以及术后即刻NIHSS评分是后循环梗死患者血管内治疗短期预后的可能影响因素,术后应加强对患者上述指标的评估并进行积极治疗,以期达到最佳预后结局。Objective To explore the influencing factors for short-term prognosis after endovascular treatment in elderly patients with posterior circulation infarction(POCI).Methods A retrospective analysis was performed on the clinical data of 50 elderly patients with POCI who received endovascular treatment in the Nuclear Industry 416 Hospital from January 2019 to December 2020.The clinical data included patients’preoperative general status(age,sex,smoking history,and alcohol abuse history),past disease history(diabetes,hypertension,hyperuricemia,and transient ischemic attack),post-onset indicators[onset-to-door time(ODT),door-to-needle time(DNT),NIH Stroke Scale(NIHSS)on admission],and postoperative conditions(immediate postoperative NIHSS,revascularization,and postoperative complications).The patients were divided into good prognosis group and poor prognosis group according to modified Rankin Scale(mRS)score 90 d after endovascular treatment and were analyzed for the differences in the above indicators.Meanwhile,a multivariate logistic regression analysis was performed on the influencing factors for patients’short-term prognosis after endovascular treatment.Results There were 20 and 30 patients in the good prognosis group and poor prognosis group,respectively,demonstrating significant differences between the two groups in nine indicators[systolic blood pressure,glycosylated hemoglobin(HbA1c),serum uric acid,total cholesterol,postoperative modified Thrombolysis in Cerebral Infarction(mTICI)grade,preoperative NIHSS score,immediate postoperative NIHSS score,ODT,and postoperative stroke-related pneumonia](t=2.30-4.13,χ^(2)=6.35,7.07,P<0.05).The multivariate logistic regression analysis showed that HbA1c≥6.5%,serum uric acid≥420 mmol/L(male)or 360 mmol/L(female),postoperative mTICI grade(blood vessel obstruction),and immediate postoperative NIHSS score≥10 were risk factors for patients’short-term prognosis after endovascular treatment(P<0.05).Conclusion HbA1c,serum uric acid,postoperative mTICI grade,and immedia

关 键 词：脑梗死 血管内操作 预后 影响因素分析 LOGISTIC模型 

分 类 号：R743.33[医药卫生—神经病学与精神病学]