亚急性期脑梗死患者全脑血管造影致脑栓塞的危险因素分析

Risk factors for cerebral angiography-induced cerebral embolism in patients with subacute ischemic stroke

目的探讨亚急性期脑梗死患者数字减影全脑血管造影(DSA)致脑栓塞的可能危险因素。方法 327例亚急性期脑梗死患者行全脑DSA,手术前后24h内行头颅MRI+弥散加权成像(DWI)检查,收集其临床和实验室资料。根据头颅MRI+DWI结果分为栓塞组65例和非栓塞组262例。比较2组差异筛选可能的危险因素,进一步行logistic回归分析致脑栓塞的独立危险因素。结果头颅MRI+DWI提示脑栓塞65例,其中有症状19例,无症状46例;logistic回归分析显示,年龄≥65岁、空腹血糖≥11.1mmol/L、纤维蛋白原≥5.0g/L、颈动脉斑块、Ⅲ型主动脉弓、手术操作时间≥30min是脑栓塞的独立危险因素(P<0.05)。结论高龄、高纤维蛋白原水平、颈动脉斑块和Ⅲ型主动脉弓、血糖控制不佳及手术时间操作过长的亚急性脑梗死患者行全脑DSA易发生脑栓塞,临床上对该类高危患者必须加以重视,慎重筛选造影患者。

Objective To study the possible risk factors for cerebral DSA-induced cerebral embol ism in patients with subacute ischemic stroke. Methods Clinical and laboratory data about 327 patients with subacute ischemic stroke were collected 24 h after they underwent DSA followed by MRI＋diffusion-weighted magnetic resonance imaging （DWI）. The patients were divided into em bolism group （n=65） and non-embolism group （n= 262）. Their possible risk factorcs were com- pared. The independent risk factors for cerebral embolism were analyzed by logistic regression analysis. Results MRI＋DWI demonstrated embolism in 65 patients （19 with sympotoms and 46 without symptoms）. Logistic regression analysis showed that age ≥65, fasting blood glucose 11.1 mmol/L, fibrinogen ≥5. 0 g/L, carotid artery plaques, type Ⅲ aortic arch, and operation time ≥30 rain were the independent risk factors for cerebral embolism （P〈0.05）. Conclusion Advanced age,high fibrinogen level,carotid artery plaques,poor control of fasting blood glucose, carotid artery plaques,type Ⅲ aortic arch and long operation time are the independent risk factors for DSA-induced cerebral embolism in patients with subacute iscbemic stroke.