急性大血管闭塞性脑卒中机械取栓术后出血转化影响因素分析  

Analysis of factors affecting hemorrhage conversion after mechanical thrombectomy in acute large vessel occlusive stroke

作　　者：黎彪 季一飞[1] LI Biao;JI Yifei(Department of Neurology,Nanchong Central Hospital,Affiliated to North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属南充市中心医院神经内科,四川南充637000

出　　处：《西部医学》2025年第4期552-557,563,共7页Medical Journal of West China

基　　金：四川省自然科学基金面上项目(22NSFSC1962)。

摘　　要：目的探究急性大血管闭塞性脑卒中机械取栓术后出血转化的影响因素及建立风险预测模型。方法纳入我院2020年7月—2023年11月急性大血管闭塞性脑卒中并行机械取栓共262例病例,根据术后即刻头颅CT及术后24 h头颅CT分为出血组(80例)和非出血组(182例)。统计两组一般资料、实验室资料和手术资料,对收集的资料进行单因素分析和多因素Logistic回归分析并建立预测模型,将预测模型与ASIAN模型进行对比。结果单因素分析结果显示,术前美国国立卫生研究院卒中量表(NIHSS)评分、术前血压、Alberta卒中早期项目CT(ASPECT)评分、AST、D-二聚体、取栓方式、术中替罗非班应用、抽吸次数等参数比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,术前NIHSS评分(OR=0.905)、ASPECT评分(OR=3.541)、取栓方式(球囊+抽吸)(OR=3.683)、术中替罗非班应用(OR=0.147)为急性大血管闭塞性脑卒中机械取栓术后颅内出血转化的独立影响因素(P<0.05)。预测模型ROC曲线下面积为0.868;预测模型与ASIAN模型无显著差异。结论术前NIHSS评分、ASPECT评分、取栓方式(球囊+抽吸)、术中替罗非班应用为急性大血管闭塞性脑卒中机械取栓术后颅内出血转化的独立影响因素。Objective To investigateinfluencing factors of hemorrhage conversion after mechanical thrombolysis in acute large vessel occlusive stroke and establish risk prediction model.Methods A total of 262 cases of acute large-vessel occlusive stroke with concomitant mechanical thrombolysis in Nanchong Central Hospital from July 2020 to November 2023 were included,and they were divided into hemorrhagic group(80 cases)and non-hemorrhagic group(182 cases)according to the immediate postoperative cranial CT and the 24-hour postoperative cranial CT.General,laboratory and surgical data of the 2 groups were counted,and the collected data were analyzed by univariate and multivariate logistic regression analyses and a predictive model was developed to compare the predictive model with the ASIAN model.Results Univariate analysis showed that the differences were statistically significant(P<0.05)when comparing the parameters of preoperative NIHSS score,preoperative blood pressure,ASPECT score,aspartate aminotransferase(AST),D-dimer,method of bolus extraction,intraoperative tirofiban application,and number of suctioning times;and multifactorial Logistic regression analysis showed that:preoperative NIHSS score(OR=0.905),ASPECT score(OR=3.541),bolus extraction method(Balloon+suction)(OR=3.683),intraoperative tirofiban application(OR=0.147)were independent influencing factors(P<0.05)for the conversion of intracranial hemorrhage after mechanical embolization in acute large vessel occlusive stroke.The area under the ROC curve of the predictive model was 0.868,there was no significant difference between the predictive model and the ASIAN model.Conclusion Preoperative NIHSS score,ASPECT score,embolization method(Balloon+suction),and intraoperative tirofiban application are independent influences on the conversion of intracranial hemorrhage after mechanical embolization in acute large vessel occlusive stroke.

关 键 词：急性大血管闭塞性脑卒中 机械取栓 影响因素 预测模型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]