大血管闭塞所致轻型缺血性卒中患者早期神经功能恶化:危险因素和补救性血管内血栓切除术对出院时转归的影响  

Early neurological deterioration in patients with minor ischemic stroke caused by large vessel occlusion:risk factors and the impact of rescue endovascular thromboectomy on outcomes at discharge

作　　者：马晨晨 王猛猛 丁俭 吴婷 盛世英[1] 李翰青 刘猛[1] Ma Chenchen;Wang Mengmeng;Ding Jian;Wu Ting;Sheng Shiying;Li Hanqing;Liu Meng(Department of Neurology,the Third Affiliated Hospital of Soochow University,Changzhou 213004,China;Department of Neurology,Changzhou Dingwu Hospital,Changzhou 213034,China)

机构地区：[1]苏州大学附属第三医院神经内科,常州213004 [2]常州鼎武医院神经内科,常州213034

出　　处：《国际脑血管病杂志》2023年第5期321-326,共6页International Journal of Cerebrovascular Diseases

基　　金：常州市科技计划资助项目(CJ20220201)。

摘　　要：目的探讨大血管闭塞(large vessel occlusion,LVO)所致轻型缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的危险因素及补救性血管内血栓切除术(rescue endovascular thromboectomy,REVT)对END患者出院时临床转归的影响。方法回顾性连续纳入苏州大学附属第三医院2021年1月至2023年3月期间在发病后24 h内入院的LVO所致轻型缺血性卒中患者。轻型缺血性卒中定义为基线美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分≤5分。END定义为入院最佳药物治疗后24 h内NIHSS评分较基线增加≥4分。采用改良Rankin量表对END患者出院时临床转归进行评估,0~2分定义为转归良好。采用多变量logistic回归分析确定END的独立危险因素以及REVT对END患者临床转归的影响。结果共纳入75例LVO所致轻型缺血性卒中患者,其中31例(41.3%)发生END,13例(41.9%)在END后进行REVT。多变量logistic回归分析显示,颈内动脉闭塞是END的独立危险因素(优势比4.304,95%置信区间1.213~15.270;P=0.024),REVT是END患者转归良好的独立保护因素(优势比0.068,95%置信区间0.006~0.774;P=0.030)。结论LVO所致轻型缺血性卒中患者的END发生率较高,颈内动脉闭塞是发生END的独立危险因素。在END后予以REVT可改善END患者出院时临床转归。Objective To investigate the risk factors of early neurological deterioration(END)in patients with minor ischemic stroke caused by large vessel occlusion(LVO)and the impact of rescue endovascular thromboectomy(REVT)on clinical outcomes of patients with END at discharge.Methods Consecutive patients with acute minor ischemic stroke caused by LVO within 24 h of onset in the Third Affiliated Hospital,Soochow University from January 2021 to March 2023 were retrospectively enrolled.Minor ischemic stroke was defined as baseline National Institute of Health Stroke Scale(NIHSS)score≤5 at admission.END was defined as an increase of≥4 in the NIHSS score within 24 h after the best medical management.The modified Rankin Scale was used to evaluate the clinical outcomes of patients with END at discharge.0-2 was defined as a good outcome.Multivariate logistic regression analysis was used to identify the independent risk factors for END and the impact of REVT on clinical outcomes in patients with END.Results A total of 75 patients with minor ischemic stroke caused by LVO were included,of which 31(41.3%)developed END and 13(41.9%)underwent REVT after END.Multivariate logistic regression analysis showed that internal carotid artery occlusion was an independent risk factor for END(odds ratio 4.304,95%confidence interval 1.213-15.270;P=0.024),and REVT was an independent protective factor for good outcomes in patients with END(odds ratio 0.068,95%confidence interval 0.006-0.774;P=0.030).Conclusions The incidence of END is higher in patients with minor ischemic stroke caused by LVO,and internal carotid artery occlusion is an independent risk factor for the occurrence of END.Providing REVT after END may improve the clinical outcomes of patients with END at discharge.

关 键 词：缺血性卒中 疾病严重程度指数 疾病恶化 血管内手术 血栓切除术 危险因素 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]