伴有心房颤动的急性前循环大血管闭塞患者直接机械取栓与桥接治疗疗效对比分析  

A comparative analysis of the efficacy of direct mechanical thrombectomy versus bridging therapy in acute anterior circulation large vessel occlusion patients with atrial fibrillation

作　　者：杜凯 朱珏华 蔡秀英[2] 龚洁芹 李继珍[1] 陈寒春[3] 茅怡铭 方琪[2] Du Kai;Zhu Juehua;Cai Xiuying;Gong Jieqin;Li Jizhen;Chen Hanchun;Mao Yiming;Fang Qi(Department of Neurology,Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou 215028,China;Department of Neurology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurosurgery,Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou 215028,China;Department of Thoracic Surgery,Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou 215028,China)

机构地区：[1]上海交通大学医学院苏州九龙医院神经内科,苏州215028 [2]苏州大学附属第一医院神经内科,苏州215006 [3]上海交通大学医学院苏州九龙医院神经外科,苏州215028 [4]上海交通大学医学院苏州九龙医院胸外二科,苏州215028

出　　处：《中华神经科杂志》2025年第3期277-285,共9页Chinese Journal of Neurology

基　　金：苏州九龙医院科研预研项目(SZJL202304)。

摘　　要：目的比较伴有心房颤动的急性前循环大血管闭塞患者直接机械取栓(简称直接取栓)与桥接治疗的疗效及安全性差异。方法回顾性收集2018年1月1日至2022年12月31日在苏州大学附属第一医院和上海交通大学医学院苏州九龙医院神经内科、神经外科或介入科因伴有心房颤动的急性前循环大血管闭塞而行机械取栓住院患者的资料。按是否使用静脉溶栓治疗,将患者分为直接取栓组和桥接治疗组,比较两组患者的临床预后及安全性指标差异。主要临床结局包括90 d改良Rankin量表(mRS)评分和90 d神经功能独立的比例(90 d改良Rankin量表评分为0~2分患者所占比例),安全性指标包括90 d病死率、颅内出血率、症状性颅内出血[神经功能恶化且美国国立卫生研究院卒中量表(NIHSS)评分上升≥4分]率、肺炎发生率。将90 d预后良好与否作为因变量,采用二元Logistic回归分析方法分析影响患者90 d预后不良的因素。结果在筛选的534例患者中,共入组125例,其中直接取栓组74例,桥接治疗组51例,直接取栓组与桥接治疗组患者的90 d mRS评分[2(0,3)分比3(1,3)分,Z=-1.444,P=0.149]差异无统计学意义,90 d神经功能独立的患者比例[66.2%(49/74)比47.1%(24/51),χ^(2)=4.561,P=0.033]差异有统计学意义,90 d病死率[5.4%(4/74)比9.8%(5/51),χ^(2)=0.936,P=0.483]、颅内出血率[17.6%(13/74)比29.4%(15/51),χ^(2)=2.437,P=0.119]、症状性颅内出血率[12.2%(9/74)比23.5%(12/51),χ^(2)=2.791,P=0.095]、肺炎发生率[59.5%(44/74)比56.9%(29/51),χ^(2)=0.084,P=0.772]差异均无统计学意义(均P>0.05)。直接取栓组与桥接治疗组患者的入院到穿刺时间分别为97(74,122)min和150(127,168)min,差异有统计学意义(Z=-5.846,P<0.001)。二元Logistic回归分析结果显示,静脉溶栓(调整后的OR=3.004,95%CI 1.057~8.539,P=0.039)、发病时NIHSS评分(调整后的OR=1.096,95%CI 1.009~1.191,P=0.030)、肺炎(调整后的OR=12.814,95%CI 3.775~43.499,P<0.00ObjectiveTo compare the efficacy and safety differences between direct mechanical thrombectomy(abbreviated as direct thrombectomy)and bridging therapy in patients with acute anterior circulation large vessel occlusion and atrial fibrillation.MethodsA retrospective collection of data was conducted for hospitalized patients who underwent mechanical thrombectomy due to acute anterior circulation large vessel occlusion with atrial fibrillation at the First Affiliated Hospital of Soochow University and Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine from January 1,2018 to December 31,2022.Patients were divided into direct thrombectomy and bridging therapy groups based on whether intravenous thrombolysis was used,and the clinical outcomes and safety indicators of the two groups were compared.The primary clinical outcomes included the modified Rankin Scale(mRS)score at 90 days and the proportion of patients with neurological independence at 90 days(the proportion of patients with mRS scores of 0-2).Safety indicators included 90-day mortality rate,intracranial hemorrhage rate,symptomatic intracranial hemorrhage[deterioration of neurological function and an increase of≥4 points in the National Institutes of Health Stroke Scale(NIHSS)score]rate,and pneumonia incidence.Using the 90-day prognosis as a dependent variable,a binary Logistic regression analysis was conducted to investigate the factors influencing poor prognosis in patients at 90 days.ResultsAmong the 534 screened patients,125 were included in the study,with 74 in the direct thrombectomy group and 51 in the bridging therapy group.The difference in the mRS scores at 90 days between the direct thrombectomy group and the bridging therapy group was not statistically significant[2(0,3)vs 3(1,3),Z=-1.444,P=0.149].The difference in the proportion of patients with independent neurological function at 90 days[66.2%(49/74)vs 47.1%(24/51),χ^(2)=4.561,P=0.033]was statistically significant between the 2 groups.The 90-day mortality rate[5.4%(4/74)vs

关 键 词：卒中 心房颤动 直接取栓 桥接取栓 

分 类 号：R541.75[医药卫生—心血管疾病] R743.3[医药卫生—内科学]