介入取栓治疗急性缺血性脑卒中预后不良的临床特征与风险因素分析  

Analysis of clinical features and risk factors of poor prognosis in acute ischemic stroke patients undergoing interventional thrombectomy

作　　者：张鹏[1] 王玉峰[1] 王龙 吕林亚 张永森[1] Zhang Peng;Wang Yufeng;Wang Long;Lu Linya;Zhang Yongsen(Department of Neurosurgery,The Third Affiliated Hospital of Xinxiang Medical College,Henan,Xinxiang 453000 China)

机构地区：[1]新乡医学院第三附属医院神经外科,河南新乡453000

出　　处：《中国微侵袭神经外科杂志》2024年第5期274-278,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的分析介入取栓治疗急性缺血性脑卒中(acute ischemic stroke,AIS)预后不良的临床特征及风险因素。方法回顾性分析172例AIS病例资料,均行介入取栓治疗。术后随访3个月,预后情况根据改良Rankin量表(modified Rankin scale,mRS)分为预后不良组(mRS 3~5分)69例和预后良好组(mRS 0~2分)103例。通过单因素及多因素Logistic分析,研究AIS患者介入取栓治疗预后不良的临床特征及风险因素。结果术后随访3个月,预后不良组69例,发生率40.12%。与预后良好组比较,预后不良组年龄>60岁比例更高,发病至入院时间、术前美国国立卫生院卒中量表(national institute of health stroke scale,NIHSS)评分、术前Alberta急性脑卒中分级早期CT(Alberta stroke program early CT,ASPECT)评分、取栓次数、入院时血糖水平、入院时同型半胱氨酸(Hcy)水平更高(均P<0.05)。多因素Logistic分析结果显示:AIS介入取栓治疗预后不良的危险因素包括发病至入院时间延长、术前NIHSS评分、术前ASPECT评分、入院时血糖水平升高(OR分别为1.813、1.990、1.782、2.335,均P<0.05)。结论AIS患者介入取栓治疗预后不良的危险因素包括发病至入院时间延长,NIHSS评分、ASPECT评分、血糖水平升高,可据此筛选具备低风险因素的患者进行干预,针对性制定预防措施,进而改善患者预后。Objective To analyze the clinical features and risk factors of poor prognosis in acute ischemic stroke(AIS)patients undergoing interventional thrombectomy.Methods The data of 172 patients with AIS,and all of them underwent interventional thrombectomy,were analyzed retrospectively.After 3 months of follow-up,these patients based on the prognosis were divided into 69 cases in the poor prognosis group(mRS 3-5 points)and 103 cases in the good prognosis group(mRS 0-2 points)according to the modified Rankin scale(mRS).Univariate and multivariate logistic analyses were used to study the clinical features and risk factors of poor prognosis after interventional thrombectomy in AIS patients.Results After 3 months of postoperative follow-up,there were 69 cases in the poor prognosis group,with an incidence rate of 40.12%.Compared with the good prognosis group,the poor prognosis group had a higher proportion of age>60 years,longer time from onset to admission,and higher preoperative National Institutes of Health Stroke Scale(NIHSS)score,preoperative Alberta stroke program early CT(ASPECT)score,number of thrombectomy,and blood glucose and homocysteine(Hcy)levels at admission(all P<0.05).The results of multivariate logistic analysis showed that the risk factors for poor prognosis of AIS-interventional thrombectomy included prolonged time from onset to hospital admission,increased NIHSS score,ASPECT score,and blood glucose level(OR was 1.813,1.990,1.782,and 2.335 respectively,all P<0.05).Conclusions The risk factors for poor prognosis of AIS patients undergoing interventional thrombectomy include prolonged time from onset to hospital admission,elevated NIHSS score,ASPECT score,and blood glucose level,thus screening the patients who have low risk factors for intervention and making the preventive measures pertinently for improving the prognosis of the patients.

关 键 词：脑卒中 缺血性 急性 介入取栓 预后不良 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]