急性椎基底动脉闭塞血管内治疗后卒中相关性肺炎的危险因素及预后分析

Risk factors and prognostic analysis of stroke-associated pneumonia after endovasculartreatment for acute vertebrobasilar artery occlusion

目的 探索急性椎基底动脉闭塞患者(VBAO)行血管内治疗后,卒中相关性肺炎(SAP的发生率、影响因素及预后情况。方法 回顾性搜集2015年12月—2018年12月,中国21家卒中中心确诊为急性VBAO,并预计于闭塞24 h内接受血管内治疗的577例患者的临床及影像资料。根据患者是否发生SAP分为SAP组368例,非SAP组209例,比较两组患者的卒中相关病史、卒中分型、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、后循环阿尔伯塔卒中项目早期CT评分、颅内血管侧支循环分级、麻醉方式、预计闭塞至穿刺时间、穿刺至再通时间、成功再通及症状性颅内出血情况,分析SAP的相关影响因素,结合90 d随访数据,进一步分析其对临床预后的影响。两组符合正态分布的计量资料以x±s表示、采用独立样本t检验,非正态分布的计量资料以M(Q_(1),Q_(3))表示、采用Mann-Whitney U检验;计数资料以例数(%)表示,采用χ^(2)检验;单因素分析中P<0.1的参数纳入以SAP为因变量的多因素logistic回归进行分析。结果 与非SAP组相比,SAP组的NIHSS评分更高、GCS评分更低、颅内血管侧支循环情况更差、全身麻醉占比更高、穿刺至再通时间更长,差异均有统计学意义(P均<0.05),其他基线资料差异均无统计学意义(P均>0.05)。多因素logistic回归分析结果显示,GCS评分(OR:0.908,95%CI:0.860~0.960,P=0.001)、全身麻醉(OR:2.507,95%CI:1.519~4.138,P<0.001)、穿刺至再通时间长(OR:1.003,95%CI:1.000~1.006,P=0.033)是SAP的独立危险因素。预后相关分析显示,SAP与90 d良好预后呈显著负相关(OR:0.605,95%CI:0.386~0.948,P=0.028)。结论 VBAO血管内治疗患者发生SAP的独立危险因素是GCS评分较低,全身麻醉及较长的穿刺至再通时间,合并SAP的患者预后更差。

Objective To explore the incidence,influencing factors,and prognosis of stroke-associated pneumonia(SAP)in patients with acute vertebrobasilar artery occlusion(VBAO)after endovascular treatment.Methods Clinical and imaging data of 577 patients diagnosed with acute VBAO and scheduled to undergo endovascular treatment within 24 hours of occlusion from December 2015 to December 2018 at 21 stroke centers in China were retrospectively collected.Patients were divided into the SAP group(368 cases)and the non-SAP group(209 cases)based on the occurrence of SAP.A comparison was made between the two groups regarding stroke-related medical history,stroke subtype,National Institutes of Health Stroke Scale(NIHSS)score,Glasgow Coma Scale(GCS)score,Alberta Stroke Program Early CT Score,intracranial vascular collateral circulation grading,anesthesia method,time from occlusion to puncture,puncture to reperfusion time,successful reperfusion,and symptomatic intracranial hemorrhage.Factors related to SAP were analyzed,and the impact on clinical prognosis was further analyzed based on 90-day follow-up data.Normally distributed continuous variables were expressed as x±s and analyzed using independent sample t-test,while non-normally distributed continuous variables were expressed as M(Q_(1),Q_(3))and analyzed using Mann-Whitney U test.Categorical data were presented as number(%)and analyzed usingχ^(2) test.Parameters with P<0.1 in univariate analysis were included in the multivariate logistic regression analysis with SAP as the dependent variable.Results Compared with the non-SAP group,the SAP group had higher NIHSS scores,lower GCS scores,worse intracranial vascular collateral circulation,a higher proportion of general anesthesia,and longer puncture to reperfusion time,with statistically significant differences(all P<0.05);other baseline characteristics showed no statistically significant differences between the two groups(all P>0.05).Multivariate logistic regression analysis revealed that lower GCS score(OR:0.908,95%CI:0.860 to 0.960,P=0.001),general anesthesia(OR:2.507,95%CI:1.519 to 4.138,P<0.001),and longer puncture to reperfusion time(OR:1.003,95%CI:1.000 to 1.006,P=0.033)were independent risk factors for SAP.Prognostic analysis showed a significant negative correlation between SAP and good prognosis at 90 days(OR:0.605,95%CI:0.386 to 0.948,P=0.028).Conclusion Lower GCS score,general anesthesia and longer puncture to reperfusion time are independent risk factors for SAP in patients undergoing endovascular treatment for VBAO.Patients with SAP have a poorer prognosis.