高龄急性前循环大血管闭塞缺血性卒中患者血管内治疗预后的影响因素分析

Analysis of factors influencing the prognosis of endovascular therapy in elderly patients with acute ischemic stroke caused by anterior large vessel occlusion

目的分析影响高龄急性大血管闭塞缺血性卒中(AIS-LVO)患者血管内治疗预后的因素。方法选择2017-01~2018-12在海军军医大学(第二军医大学)长海医院脑血管病中心接受血管内治疗的AIS-LVO高龄患者66例,以治疗后3个月改良Rankin量表(mRS)评分作为预后评价指标,mRS评分≤2分的患者为预后良好组(20例),3~6分为预后不良组(46例)。分析两组患者的危险因素、神经功能状况、影像学特征等指标,采用多因素Logistic回归分析影响高龄患者血管内治疗预后的影响因素。结果血管内治疗后3个月预后良好率为30.3%(20/66),预后良好组和预后不良组患者的基线美国国立卫生研究院卒中量表(NIHSS)评分和核心梗死体积比较差异有统计学意义(P<0.05)。多因素Logistic回归分析表明,核心梗死体积>20ml(OR=3.458,95%CI:1.033~11.572,P=0.044)为AIS-LVO高龄患者血管内治疗预后不良的危险因素。结论核心梗死是影响AIS-LVO高龄患者血管内治疗预后的独立危险因素,核心梗死体积越大,预后越差。

Objective To analysis the prognostic influencing factors of acute ischemic stroke patients with large vessel occlusions(AIS-LVO)who are 80 years old and treated with endovascular therapy.Methods From January 2017 to December 2018,66 elderly patients with AIS-LVO underwent endovascular therapy in Cerebrovascular Diseases Center of Changhai Hospital of Navy Medical University(Second Military Medical University)were included in this study.The modified Rankin Scale(mRS)Score was used as a prognostic indicator 3 months after therapy.The patients with mRS score≤2 points were chosen as the good prognosis group(n=20)and the patients with mRS score being 3~6 points were chosen as the poor prognosis group(n=46).The risk factors,neurological function and imaging data of the patients were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of the prognosis of the elderly patients undergoing endovascular therapy.Results The good prognosis rate was 30.3%(20/66)at 3 months after treatment.There were significant differences in the baseline,National Institutes of Health Stroke Scale(NIHSS)score and core infarction volume of the patients between the good and the poor prognosis groups(P<0.05).Multivariate Logistic regression analysis showed that core infarction>20 ml(OR=3.458,95%CI:1.033~11.572,P=0.044)was a risk factor for poor prognosis of endovascular therapy in the elderly patients with AIS-LVO.Conclusion Core infarction is an independent risk factor affecting the prognosis of endovascular therapy in the elderly patients with AIS-LVO.The larger the volume of core infarction,the worse the prognosis.