血管内机械取栓治疗前循环大血管闭塞急性缺血性卒中的预后影响因素分析  

Retrospective analysis of prognostic factors for acute ischemic stroke with anterior circulation occlusion treated by endovascular mechanical thrombectomy

作　　者：裘天仑[1] 鲍武乔[1] QIU Tianlun;BAO Wuqiao(Department of Neurosurgery,Shaoxing People's Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院神经外科,312000

出　　处：《浙江医学》2023年第21期2283-2288,共6页Zhejiang Medical Journal

摘　　要：目的探讨血管内机械取栓(EMT)治疗前循环大血管闭塞急性缺血性卒中(AIS)的预后影响因素。方法选取2021年7月至2022年12月在绍兴市人民医院接受EMT治疗的115例前循环大血管闭塞AIS患者为研究对象,随访患者术后90 d预后情况,比较预后良好组与预后不良组临床资料,采用多因素logistic回归分析术后90 d预后的影响因素;同时对EMT术后90 d死亡的影响因素进行分析。结果115例患者EMT治疗后血管再通成功81例,占70.4%;出院时国立卫生研究院卒中量表(NHISS)评分≤10分31例,11~20分45例,>20分39例;术后90 d预后良好43例,预后不良72例(包括死亡19例)。与预后良好组比较,预后不良组患者入院时NIHSS评分、入院时改良Rankin量表(mRS)评分5分比例、出院时NIHSS评分以及术后血管狭窄、血栓扩散、自发性脑出血(sICH)比例均较高,取栓时间、血栓长度均较长、术前侧支循环代偿比例、术后改良脑梗死溶栓(mTICI)3级比例均较低,差异均有统计学意义(均P<0.05)。术前侧支循环代偿(OR=6.71)、术后血栓扩散(OR=0.036)、术后sICH(OR=0.074)、术后mTICI分级(OR=3.246)、出院时NHISS评分(OR=0.729)是EMT术后90 d预后的独立影响因素(均P<0.05);入院时NHISS评分(OR=1.033)是EMT术后90 d死亡的独立影响因素(P<0.05)。结论术前侧支循环代偿以及术后血栓扩散、sICH、mTICI分级和出院时NHISS评分是EMT术后90 d预后的独立影响因素,入院时NHISS评分是EMT术后90 d死亡的独立影响因素。Objective To analyze the clinical factors influencing the prognosis,and mortality rate in acute ischemic stroke(AIS)patients with large vessel occlusion in anterior circulation after treatment of endovascular mechanical thrombectomy(EMT).Methods A retrospective analysis was conducted on 115 discharged patients who underwent EMT for AIS of anterior circulation between July 2021 and December 2022 in Shaoxing People's Hospital.The demographic data,clinical characteristics and retrieval methods were analyzed to assess their impact on adverse outcomes(modified Rankin Scale,mRS 3-6)and mortality rate at 3 months.Logistic regression analysis was used to identify independent risk factors among statistically significant variables,and OR were calculated.Results Recanalization was observed in 81(70.4%)of all 115 patients after EMT.In terms of National Institutes of Health Stroke Scale(NIHSS),31 patients were with≤10 scores,45 with 11-20 scores and 39 with>20 scores at discharge.At 90 d after surgery,43 cases showed good prognosis,while 72 showed poor prognosis(including 19 deaths).Compared with good prognosis group,the poor prognosis group had higher initial NIHSS scores on admission,proportion of patients with 5 scores of modified Rankin Scale(mRS)on admission,NIHSS scores at discharge,and proportions of vascular stenosis after EMT,thrombus propagation and postoperative symptomatic intracranial hemorrhage(sICH)(all P<0.05),and had longer thrombectomy duration and thrombus length(both P<0.05).On the contrary,proportions of preoperative compensatory collateral circulation and postoperative grade 3 modified Thrombolysis in Cerebral Infarction(mTICI)in patients with poor prognosis were significantly lower than those with good prognosis(both P<0.05).Logistic regression analysis showed that preoperative collateral circulation compensation(OR=6.71),postoperative thrombus propagation(OR=0.036),postoperative mTICI(OR=3.246),and postoperative sICH(OR=0.074),NIHSS at discharge(OR=0.729)were independent risk factors influencing prog

关 键 词：急性缺血性卒中 血管内机械取栓 前循环 侧支循环代偿 脑出血 预后 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]