机械取栓治疗大血管闭塞急性缺血性脑卒中预后的多因素分析

doi:10.19854/j.cnki.1008-2425.2023.01.0008

摘要/Abstract

摘要： 目的评估机械取栓在治疗急性缺血性脑卒中(acute ischemic stroke,AIS)的有效性和安全性,探讨机械取栓术后影响临床预后的因素。方法回顾性分析蚌埠医学院第二附属医院脑病中心自2019年9月至2021年12月行机械取栓治疗的AIS患者133例,通过术后90d的改良Rankin量表(mRS)评分来确定预后,mRS评分≤3分定义为预后良好,将mRS＞3分定义为预后不良。采用单因素和多因素logistic回归分析探究影响患者预后的因素。结果单因素分析提示:与预后不良组相比,预后良好组患者术前NIHSS评分低,术中取栓次数少,术后严重并发症少,住院时间短,当然血管再通良好是患者预后良好的前提,两组患者上述资料有统计学差异(P＜0.05)。多因素logistic回归分析提示:年龄、术前NIHSS评分和术后严重并发症与患者预后显著相关(P＜0.05),为影响患者预后的独立因素。结论年龄、术前NIHSS评分、和术后严重并发症均是影响大血管闭塞性AIS患者机械取栓治疗预后的重要因素。

关键词: 脑卒中, 机械取栓, 预后, 多因素分析

Abstract: Objective To evaluate the efficacy and safety of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS),and to explore the factors affecting the clinical prognosis after mechanical thrombectomy.Methods A retrospective analysis was performed on 133 AIS patients who underwent mechanical thrombectomy in the Encephalopathy Center of the Second Affiliated Hospital of Bengbu Medical College from September 2019 to December 2021.The prognosis was determined by the modified Rankin Scale (mRS) score 90 days post operation.mRS score≤3 was defined as good prognosis,and mRS score>3 was defined as poor prognosis.Univariate and multivariate logistic regression analysis was used to explore the prognostic factors.Results Univariate analysis showed that compared with the poor prognosis group,the patients in the good prognosis group had lower preoperative NIHSS score,less thrombectomy times,fewer serious post-operative complications,and shorter hospital stay.Of course,good recanalization was the prerequisite for a good prognosis,and there were statistically significant differences between the two groups (P＜0.05).Multivariate logistic regression analysis showed that age,preoperative NIHSS scoreand severe postoperative complications were significantly correlated with the prognosis of patients (P＜0.05),which were independent factors affecting the prognosis of patients.Conclusion Preoperative NIHSS score and severe postoperative complications are important factors affecting the prognosis of AIS patients with large vessel occlusion after mechanical thrombectomy.

Key words: Stroke, Mechanical thrombectomy, Prognosis, Multivariate analysis

中图分类号:

R743.31

范顺志, 程哲, 王大巍, 张辉, 束汉生. 机械取栓治疗大血管闭塞急性缺血性脑卒中预后的多因素分析[J]. 立体定向和功能性神经外科杂志, 2023, 36(1): 42-47.

Fan Shunzhi, Chen Zhe, Wang Dawei, et al. Multivariate analysis of the prognosis of mechanical thrombectomy in acuteischemic stroke with large vessel occlusion[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(1): 42-47.

参考文献

[1] 王陇德,彭斌,张鸿祺,等.《中国脑卒中防治报告2020》概要[J].中国脑血管病杂志,2022,19(2):136~144.
[2] Mühr O,Persson HC,Sunnerhagen KS.Long-term outcome after reperfusion-treated stroke[J].J Rehabil Med.2017 Apr 6;49(4):316~321.
[3] 吴明超,曹铭华,江顺福,等.静脉溶栓与机械取栓治疗急性脑梗死的效果及对NIHSS评分的影响[J].中国医学创新,2022,19(1):25~28.
[4] 马涛,郭文婷,宋丹利,等.不同年龄组急性缺血性脑卒中患者机械取栓治疗有效性和安全性的Meta分析[J].中国循证医学杂志,2020,20(4):412~417.
[5] Sprügel MI,Kuramatsu JB,Gerner ST,et al.Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage[J].Cerebrovasc Dis.2017;44(3-4):186~194.
[6] Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].N Engl J Med,2015,Jan 1;372(1):11~20.
[7] Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Engl J Med,2015,372(11):1019~30.
[8] Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372(11):1009~18.
[9] Saver JL,Goyal M,Bonafe A,et al.Stent-retriever thrombectomy after intravenous t-PA vs.t-PA alone in stroke[J].N Engl J Med,2015,372(24):2285~95.
[10] Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8 hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372(24):2296~306
[11] Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723~1731.
[12] Chandra RV,Leslie-Mazwi TM,Oh DC,et al.Elderly patients are at higher risk for poor outcomes after intra-arterial therapy[J].Stroke,2012,43(9):2356~2361.
[13] Boers AMM,Jansen IGH,Beenen LFM,et al.Association of follow-up infarct volume with functional outcome in acute ischemic stroke:a pooled analysis of seven randomized trials[J].J Neurointerv Surg,2018,10(12):1137~1142.
[14] 陈正文,李沛城,陈珑,等.后循环急性缺血性脑卒中患者经机械取栓完全复流后不良预后的影响因素分析[J].中华介入放射学电子杂志,2022,10(1):22~26.
[15] Powers WJ,Derdeyn CP,Biller J,et al.2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2015,46(10):3020~3035.
[16] Hendrix P,Melamed I,Collins M,et al.NIHSS 24?h After Mechanical Thrombectomy Predicts 90-Day Functional Outcome[J].Clin Neuroradiol,2022,32(2):401~406.
[17] Pedraza MI,de Lera M,Bos D,et al.Brain Atrophy and the Risk of Futile Endovascular Reperfusion in Acute Ischemic Stroke[J].Stroke,2020,51(5):1514~1521.
[18] Nie X,Pu Y,Zhang Z,et al.Futile Recanalization after Endovascular Therapy in Acute Ischemic Stroke[J].Biomed Res Int,2018,9,2018:5879548.
[19] Espinosa de Rueda M,Parrilla G,Manzano-Fernández S,et al.Recanalization After Thrombectomy in Patients With Acute Stroke[J].Stroke,2015,46(9):2517~2522.
[20] Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723~1731.
[21] 中国急性脑梗死后出血转化诊治共识2019[J].中华神经科杂志,2019(4):252~265.
[22] Huang X,Yang Q,Shi X,et al.Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke[J].J Neurointerv Surg,2019,11(10):994~998.
[23] Snyder T,Agarwal S,Huang J,et al.Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy:Stratification by Arrival Time and ASPECTS[J].J Neuroimaging,2020,30(5):625~630.
[24] Spiotta AM,Vargas J,Hawk H,et al.Impact of the ASPECT scores and distribution on outcome among patients undergoing thrombectomy for acute ischemic stroke[J].J Neurointerv Surg,2015,7(8):551~558.
[25] Adusumilli G,Pederson JM,Hardy N,et al..Mechanical thrombectomy in anterior vs.posterior circulation stroke:A systematic review and meta-analysis[J].Interv Neuroradiol,2022,13:15910199221100796.
[26] Lee SH,Han JH,Jung I,et al.Do thrombolysis outcomes differ between anterior circulation stroke and posterior circulation stroke? A systematic review and meta-analysis[J].Int J Stroke,2020,15(8):849~857.
[27] Weber R,Minnerup J,Nordmeyer H,et al.Thrombectomy in posterior circulation stroke:differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry[J].Eur J Neurol,2019,26(2):299~305.