急性前循环大血管闭塞成功再通后延迟性神经功能改善的预测因素分析  

Predictors of delayed neurological improvement after successful recanalization of acute anterior circulation large vessel occlusion

作　　者：蓝文雅[1] 杜娟[2] 邱峰[1] 姜海波[1] 杜明洋[1] 许丽丽 曹辉[1] LAN Wenya;DU Juan;QIU Feng;JIANG Haibo;DU Mingyang;XU Lili;CAO Hui(Department of Cerebrovascular Disease Treatment Center,Affiliated Nanjing Brain Hospital,Nanjing Medical University,Nanjing 210029,Jiangsu,China;Department of Neurology,Nanjing Drum Tower Hospital Group Suq-ian Hospital,Suqian 223800,Jiangsu,China)

机构地区：[1]南京医科大学附属脑科医院脑血管病救治中心,南京210029 [2]南京鼓楼医院集团宿迁市人民医院神经内科,宿迁223800

出　　处：《医学研究与战创伤救治》2024年第7期709-714,共6页Journal of Medical Research & Combat Trauma Care

基　　金：国家自然科学基金(82001260)。

摘　　要：目的探讨急性前循环大血管闭塞患者血管成功再通后延迟性功能改善(DFI)的发生率及其预测因素。方法回顾性收集2017年12月至2021年12月期间在南京医科大学附属脑科医院和南京鼓楼医院集团宿迁医院神经内科接受急诊血管再通的急性前循环大血管闭塞患者的临床资料。早期神经功能改善(EFI)定义为对于美国国立卫生研究院卒中量表(NIHSS)评分4分以上的患者在血管成功再通24 h后有4分以上的改善;或对于NIHSS评分≤4分的患者,血管再通24 h后NIHSS评分降至0或1分。DFI定义为早期神经功能无改善的患者90 d改良RANKIN量表(mRS)评分0~2分。将单因素分析中P<0.1的变量纳入多变量logistic回归模型,确定DFI的独立影响因素。结果根据纳入和排除标准,最终347例患者进入统计分析。平均年龄65岁,男性占比62%,中位NIHSS16分。在347例患者中,185例(53.3%)患者发生EFI。与非EFI组患者相比,EFI组患者年龄(P=0.028)和基线NIHSS评分(P=0.007)更低,症状性颅内出血(P<0.001)以及肺部感染(P=0.002)的发生率更低。在162例非EFI患者中,36例(22.2%)患者出现DFI。与非DFI组患者相比,DFI组患者年龄(P<0.001)和基线NIHSS评分(P<0.001)更低,房颤(P=0.008)以及症状性颅内出血(P=0.003)发生比例更低,而吸烟患者的构成比更高(P=0.035)。多变量logistic回归分析显示年龄[OR=0.94,95%CI=0.89~0.98]、基线NIHSS评分(OR=0.88,95%CI 0.81~0.96)、侧支循环(OR=8.33,95%CI 2.41~28.82)以及症状性颅内出血(OR=0.20,95%CI 0.04~0.93)是DFI的独立预测因素。结论在急性前循环大血管闭塞成功再通的患者中,超过一半比例患者发生EFI,而在非EFI患者中也有超过20%的患者发生DFI。年龄、基线NIHSS评分、侧支循环以及症状性颅内出血对于DFI发生至关重要。需关注以上因素以加强对急性大血管闭塞机械取栓的管理。Objective To determine the prevalence and predictors of delayed function improvement(DFI)after successful re-perfusion in patients with acute anterior circulation large vessel occlu-sion(ALVO).Methods From December 2017 to December 2021,patients with ALVO who received emergency vascular recanali-zation in the Department of Cerebrovascular Disease Treatment Cen-ter,Nanjing Brain Hospital Affiliated to Nanjing Medical University and Nanjing Drum Tower Hospital Group Suqian Hospital were retro-spectively collected.Early neurological improvement(EFI)was de-fined as an improvement of more than 4 points for patients with a Na-tional Institutes of Health Stroke Scale(NIHSS)score above 4 points after 24 hours of successful revascularization;or for patients with NIHSS score≤4,the NIHSS score decreased to 0 or 1 after 24 hours of vascular recanalization.We defined DFI as the patients with ALVO who did not experience early functional improvement despite complete recanalization after EVT and still achieved a 90-day modified Rankin Scale(mRS)score of 0-2.Variables with P<0.1 in the univariate analysis were included in the multivariate logistic regression model to determine the independent influencing factors of DFI.Results According to the inclusion and exclusion criteria,347 patients with ALVO who received emergency vascular recanali-zation were analyzed.The average age of the study population was 65 years,62%were male,and the median NIHSS score was 16.Of 347 patients,185(53.3%)developed EFI.Patients in the EFI group had lower age(P=0.028)and baseline NIHSS score(P=0.007),as well as a lower incidence of symptomatic intracranial hemorrhage(P<0.001)and lung infection(P=0.002)than patients in the non-EFI group.Of 162 non-EFI patients,36(22.2%)developed DFI.Compared with the non-DFI group,patients in the DFI group had low-er age(P<0.001)and baseline NIHSS score(P<0.001),a lower incidence of atrial fibrillation(P=0.008)and symptomatic intracrani-al hemorrhage(P=0.003),and a higher proportion of smokers(P=0.035).Multivariate log

关 键 词：急性大血管闭塞 血管再通 延迟性功能改善 早期神经功能改善 

分 类 号：R743[医药卫生—神经病学与精神病学]