前循环大血管闭塞性卒中患者血管内治疗后早期神经功能恶化的预测因素  

Predictors of early neurological deterioration after endovascular therapy in patients with large vessel occlusive stroke in anterior circulation

作　　者：周庆 张晓鸽 高旸 左朦 Zhou Qing;Zhang Xiaoge;Gao Yang;Zuo Meng(Department of Neurology,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Chongqing Center for Disease Control and Prevention,Chongqing 400042,China)

机构地区：[1]陆军军医大学第一附属医院神经内科,重庆400038 [2]重庆市疾病预防控制中心,重庆400042

出　　处：《国际脑血管病杂志》2024年第9期648-653,共6页International Journal of Cerebrovascular Diseases

基　　金：国家卫生健康委员会脑卒中高危人群筛查和干预项目(Z135080000022)。

摘　　要：目的探讨前循环大血管闭塞性卒中患者血管内治疗(endovascular treatment,EVT)后早期神经功能恶化(early neurological deterioration,END)的影响因素。方法回顾性纳入2017年1月至2021年4月期间在西南医院和自贡市第三人民医院接受EVT治疗的急性前循环大血管闭塞性卒中患者。根据EVT后是否发生END将患者分为END组和非END组。比较2组人口统计学和临床资料。应用多变量logistic回归分析确定EVT后END的独立相关因素。结果共纳入359例患者,男性191例(53.2%),年龄(69.30±12.07)岁,73例(20.3%)发生END。单变量分析显示,END组中性粒细胞计数以及任何颅内出血、有症状颅内出血(symptomatic intracranial hemorrhage,sICH)、侧支循环不良的患者构成比显著高于非END组,但舒张压以及血管成功再通的患者构成比显著低于非END组(P均<0.05)。多变量logistic回归分析显示,侧支循环良好[优势比(odds ratio,OR)0.538,95%置信区间(confidence interval,CI)0.306~0.945;P=0.031]和血管成功再通(OR 0.244,95%CI 0.095~0.629;P=0.003)是EVT后END的独立保护因素,而sICH是EVT后END的独立危险因素(OR 3.884,95%CI 1.426~10.579;P=0.008)。结论侧支循环不良、sICH以及血管未成功再通的急性前循环大血管闭塞性卒中患者在EVT后更易发生END。应重点关注以上危险因素,及时采取有效措施以预防END的发生。Objective To investigate the predictors of early neurological deterioration(END)after endovascular therapy(EVT)in patients with large vessel occlusive stroke in anterior circulation.Methods Patients with acute large vessel occlusive stroke in anterior circulation received EVT at Southwest Hospital and Zigong Third People's Hospital from January 2017 to April 2021 were included retrospectively.The patients were divided into END group and non-END group based on whether END occurred after EVT.The demographic and clinical data of the two groups were compared.Multivariate logistic regression analysis was used to determine the independent correlation factors of END after EVT.Results A total of 359 patients were enrolled,including 191 males(53.2%),aged 69.30±12.07 years,and 73 patients(20.3%)had END.Univariate analysis showed that neutrophil count,the proportion of patients with any intracranial hemorrhage,symptomatic intracranial hemorrhage(sICH),and poor collateral circulation in the END group was significantly higher than that in the non-END group,but diastolic blood pressure and the proportion of patients with successful recanalization was significantly lower than that in the non-END group(all P<0.05).Multivariate logistic regression analysis showed that good collateral circulation(odds ratio[OR]0.538,95%confidence interval[CI]0.306-0.945;P=0.031)and successful recanalization(OR 0.244,95%CI 0.095-0.629;P=0.003)were the independent protective factors of END after EVT,while sICH was an independent risk factor for END after EVT(OR 3.884,95%CI 1.426-10.579;P=0.008).Conclusions Patients with acute large vessel occlusive stroke in anterior circulation with poor collateral circulation,sICH,and unsuccessful recanalization are more likely to have END after EVT.Attention should be paid to the above risk factors and effective measures should be taken timely to prevent the occurrence of END.

关 键 词：缺血性卒中 血管内手术 血栓切除术 疾病恶化 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]