基于不同NIHSS评分的急性脑血管闭塞患者SWIM技术治疗预后及影响因素分析  

Analysis of prognosis and influencing factors of SWIM technique in patients with acute cerebral vascular occlusion based on different NIHSS scores

作　　者：姚广明 田甜[1] 孙文浩[1] 张继伟[1] 呼铁民[1] YAO Guangming;TIAN Tian;SUN Wenhao;ZHANG Jiwei;HU Tiemin(Department of Neurosurgery,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China)

机构地区：[1]承德医学院附属医院神经外科,承德067000

出　　处：《医学研究与战创伤救治》2023年第9期954-960,共7页Journal of Medical Research & Combat Trauma Care

基　　金：河北省卫生健康委科研基金(20220429)。

摘　　要：目的通过SWIM技术治疗急性脑血管闭塞患者,分析不同NIHSS评分患者治疗预后的相关因素,为其预后评估与治疗决策提供参考。方法选择2020年2月至2022年9月河北省承德医学院附属医院神经外科收治的NIHSS评分≥15分的急性脑血管闭塞患者。共纳入100例患者。根据入院时NIHSS评分将患者分为中重度组(15~20分,n=60)与重度组(>20分,n=40)。所有患者均接受SWIM技术治疗并随访90d,采用改良简化版Rankin量表(mRSq)评分评估患者预后,比较不同NIHSS评分患者的基线资料及预后情况,单因素与多因素Logistic回归分析检验影响患者预后的相关因素。结果100例患者中预后良好23例,预后良好率为23.00%。重度组患者急性后循环闭塞占比高于中重度组,预后良好率低于中重度组,差异有统计学意义(P<0.05)。急性后循环闭塞患者预后良好率低于急性前循环闭塞(P<0.05)。Logistic回归分析发现串联性病变、取栓次数≥2次、发病至血管再通时间>6 h是急性前循环闭塞患者预后的危险因素(P<0.05),替罗非班应用、桥接治疗、血栓负荷评分>5分是其保护因素(P<0.05)。NIHSS评分>20分、BSS评分≥3分、取栓次数≥2次、发病至血管再通时间>6 h、发生术后再出血是急性后循环闭塞患者预后的危险因素(P<0.05),BATMAN评分>5分、ASPETS评分≥7分是其保护因素(P<0.05)。结论不同NIHSS评分及闭塞部位的急性脑血管闭塞患者SWIM技术治疗后临床预后存在显著差异,重视对串联性病变、未应用替罗非班及桥接治疗、多次取栓、发病至血管再通时间长、BSS评分高、BATMAN及ASPETS评分低及术后再出血患者的干预能促进其预后改善。Objective SWIM technique was used to treat patients with acute cerebral vascular occlusion.To analyze the related factors of treatment and prognosis of patients with different NIHSS scores,and to provide reference for prognosis evaluation and treatment decision.Methods It has been selected patients with acute cerebral vascular occlusion whose NIHSS score≥15 from the neurosurgery Department of the Affiliated Hospital of Chengde Medical College,Hebei Province from February 2020 to September 2022.A total of 100 patients were included.According to the NIHSS score at admission,the patients were divided into moderate to severe group(15-20 points,n=60)and severe group(>20 points,n=40).All patients were treated with SWIM technique and followed up for 90 days.Themodified simplified Rankin Scale(mRSq)score was used to evaluate the prognosis of patients.Baseline data and prognosis of patients with different NIHSS scores were compared,and univariate and multivariate Logistic regression analysis was performed to examine the related factors affecting the prognosis of patients.Results Among the 100 patients,23 cases had good prognosis,and the good prognosis rate was 23.00%.The proportion of acute posterior circulation occlusion in severe group was higher than that in moderate and severe group,and the rate of good prognosis was lower than that in moderate and severe group,with statistical significance(P<0.05).The good prognosis rate of patients with acute posterior circulation occlusion was lower than that of patients with acute anterior circulation occlusion(P<0.05).Logistic regression analysis found that tandem lesions,thrombectomy times≥2 times,and time>6 h from onset to vascular recanalization were the risk factors for prognosis in patients with acute anterior circulation occlusion(P<0.05),while Tirofiban application,bridging therapy,and thrombus load score>5 were the protective factors(P<0.05).NIHSS score>20,BSS score≥3,number of thrombectomy≥2,time from onset to vascular revascularization>6 h,and postoperative rebl

关 键 词：急性脑血管闭塞 美国国立卫生研究院卒中量表 颅内支撑导管辅助Solitaire FR支架取栓技术 预后 影响因素 

分 类 号：R743[医药卫生—神经病学与精神病学]