大血管闭塞性急性缺血性卒中患者血管内机械取栓术后行去骨瓣减压术的影响因素  

Influencing Factors of Decompressive Craniectomy in Acute Ischemeic Stroke with Large Vessel Occlusion Patients after Endovascular Thrombectomy

作　　者：殷小焦 王健翔 高云[1] YIN Xiaojiao;WANG Jianxiang;GAO Yun(Department of Neurosurgery,Kunming First People's Hospital,Kunming 650000,China)

机构地区：[1]云南省昆明市第一人民医院神经外科,650000

出　　处：《实用心脑肺血管病杂志》2025年第6期54-57,64,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的分析大血管闭塞性急性缺血性卒中(AIS-LVO)患者血管内机械取栓术后行去骨瓣减压术(DC)的影响因素。方法选取2019年1月—2024年6月在昆明市第一人民医院和昆明市延安医院接受血管内机械取栓术的383例AIS-LVO患者作为研究对象,根据患者血管内机械取栓术后是否行DC将其分为DC组(n=27)和非DC组(n=356)。收集患者的临床资料。AIS-LVO患者血管内机械取栓术后行DC的影响因素分析采用多因素Logistic回归分析。结果两组年龄、有饮酒史者占比、有心房颤动史者占比、有高血压史者占比、行全身麻醉者占比、血管再通失败者占比、入院时中性粒细胞/淋巴细胞比值(NLR)比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,饮酒史〔OR=3.606,95%CI(1.258~10.232)〕、全身麻醉〔OR=3.239,95%CI(1.486~7.079)〕、血管再通失败〔OR=21.982,95%CI(10.393~45.831)〕、入院时NLR升高〔OR=1.018,95%CI(1.005~1.031)〕是AIS-LVO患者血管内机械取栓术后行DC的危险因素,而心房颤动史〔OR=0.232,95%CI(0.054~0.998)〕、高血压史〔OR=0.182,95%CI(0.060~0.544)〕是其保护因素(P<0.05)。结论饮酒史、全身麻醉、血管再通失败、入院时NLR较高是AIS-LVO患者血管内机械取栓术后行DC的危险因素,而心房颤动史、高血压史是其保护因素。Objective To analyze the influencing factors of decompressive craniectomy(DC)in acute ischemeic stroke with large vessel occlusion(AIS-LVO)patients after endovascular thrombectomy.Methods A total of 383 patients with AIS-LVO who underwent endovascular thrombectomy in Kunming First People's Hospital and Kunming Yan'an Hospital from January 2019 to June 2024 were selected as the research objects.According to whether the patients underwent DC after endovascular thrombectomy,the patients were divided into DC group(n=27)and non-DC group(n=356).The clinical data of the patients were collected.Multivariate Logistic regression analysis was used to analyze the influencing factors of DC in patients with AIS-LVO after endovascular thrombectomy.Results There were statistically significant differences in age,proportion of patients with history of drinkers,proportion of patients with history of atrial fibrillation,proportion of patients with history of hypertension,proportion of patients undergoing general anesthesia,proportion of patients with vascular recanalization failure,and neutrophil/lymphocyte ratio(NLR)at admission between the two groups(P<0.05).Multivariate Logistic regression analysis showed that history of drinking[OR=3.606,95%CI(1.258-10.232)],general anesthesia[OR=3.239,95%CI(1.486-7.079)],vascular recanalization failure[OR=21.982,95%CI(10.393-45.831)],and higher NLR at admission[OR=1.018,95%CI(1.005-1.031)]were risk factors of DC in patients with AIS-LVO after endovascular thrombectomy,while history of atrial fibrillation[OR=0.232,95%CI(0.054-0.998)]and history of hypertension[OR=0.182,95%CI(0.060-0.544)]were their protective factors(P<0.05).Conclusion The history of drinking,general anesthesia,vascular recanalization failure,and higher NLR at admission are risk factors of DC in patients with AIS-LVO after endovascular thrombectomy,while history of atrial fibrillation and history of hypertension are their protective factors.

关 键 词：缺血性卒中 大血管闭塞 血管内机械取栓术 去骨瓣减压术 影响因素分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]