急性前循环脑梗死血管内治疗后血管痉挛发生的影响因素及与预后的相关性  

Influencing factors for the occurrence of vasospasm after intravascular therapy in acute anterior circulation cerebral infarction and its correlation with prognosis

作　　者：熊建[1] 屈战利 任瑜 尹均明 季一飞[1] XIONG Jian;QU Zhanli;REN Yu;YIN Junming;JI Yifei(Nanchong Central Hospital/The Second Clinical College of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]南充市中心医院,川北医学院第二临床医学院,四川南充637000

出　　处：《中国实用神经疾病杂志》2024年第10期1243-1248,共6页Chinese Journal of Practical Nervous Diseases

基　　金：四川省自然科学基金项目(编号:2022NSFSC0756)。

摘　　要：目的分析急性前循环脑梗死血管内治疗后发生血管痉挛的影响因素,探讨血管痉挛对患者预后的影响。方法回顾性收集2020-01—2023-06就诊于南充市中心医院的428例急性前循环脑梗死且接受血管内治疗患者的临床资料,根据患者是否在治疗期间发生血管痉挛进行分组。比较2组临床资料,进行单因素与多因素Logistic回归分析,探讨影响血管痉挛发生的因素。比较2组改良脑梗死溶栓(mTICI)分级,分析血管痉挛是否影响患者预后。结果纳入428例患者,其中34例发生血管痉挛。单因素分析显示2组间年龄、冠心病、高血压、术前改良Rankin量表(mRS)评分、总取栓次数、支架取栓次数差异有统计学意义(P<0.05)。多因素分析表明年龄和术前mRS评分是血管痉挛发生的独立影响因素。2组间mTICI分级、术后90 d mRS评分、24 h和出院时NIHSS评分无统计学差异(P>0.05),血管痉挛未对急性前循环脑梗死患者预后产生影响。结论急性前循环脑梗死患者年龄、术前mRS评分是血管内治疗期间血管痉挛发生的独立影响因素,取栓总次数和支架取栓次数可能影响血管痉挛的发生。急性前循环脑梗死患者血管内治疗后发生血管痉挛并未降低再灌注成功的可能性,且不影响患者预后。Objective To analyze the risk factors associated with vasospasm following endovascular therapy(EVT)for acute anterior circulation cerebral infarction and investigate its impact on the prognosis of patients.Methods A retrospective analysis was conducted on the clinical data of 428 patients diagnosed with acute anterior circulation cerebral infarction who received EVT in the Nanchong Central Hospital from January 2020 to June 2023.The patients were grouped based on whether they experienced vasospasm during EVT.The clinical data of two groups were compared,and univariate and multivariate Logistic regression analyses were conducted to investigate the factors influencing the occurrence of vasospasm.The modified thrombolysis in cerebral infarction(mTICI)grade between the two groups was compared to investigate whether vasospasm affects the prognosis.Results A total of 428 patients were included,of which 34 had vasospasm.The results of the univariate analysis showed statistically significant differences between the two groups in age,coronary heart disease,hypertension,modified Rankin scale(mRS)score before surgery,total thrombus removal times,and stent thrombus removal times(P<0.05).The results of multivariate analysis indicate that age and mRS score before surgery were independent influencing factors for the vasospasm.There was no difference in mTICI,90-day mRS score,and NIHSS score at 24 hours and discharge between the two groups.Furthermore,vasospasm had no significant impact on the prognosis of individuals diagnosed with acute anterior circulation cerebral infarction.Conclusion Patients’age and mRS score before surgery are independent influencing factors for the occurrence of vasospasm during EVT,and the total of thrombus removal times and the stent thrombus removal times may affect the occurrence of vasospasm.The occurrence of vasospasm after EVT in patients with acute anterior circulation cerebral infarction did not reduce the likelihood of successful reperfusion and does not affect the prognosis.

关 键 词：急性前循环脑梗死 血管内治疗 血管痉挛 预后 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]