摘要
目的探讨前循环急性大血管闭塞性缺血性卒中(AIS)时间窗内行机械取栓术预后不良的原因。方法回顾性分析聊城市脑科医院血管神经外科自2017年1至12月收治的78例在时间窗内行机械取栓术的前循环AIS患者资料。采用改良Rankin量表(mRS)评估患者术后3个月预后情况。根据预后情况将患者分为预后良好组(42例,mRS≤2分)和预后不良组(36例,mRS≥3分),采用单因素、多因素Logistic回归分析方法,分析预后不良的相关因素。结果(1)单因素分析显示,预后良好组合并糖尿病、动脉粥样硬化性原发狭窄;7 d的美国国立卫生研究院卒中量表评分、发病到再灌注时间(TOR)低于预后不良组,P<0.05;预后良好组侧支循环代偿良好率、血管再通率高于预后不良组,P<0.05。(2)多因素分析显示:糖尿病(P=0.035)、侧支循环代偿(P=0.011)和合并动脉粥样硬化性原发狭窄(P=0.042)是预后不良的独立危险因素。结论完善的术前评估和严格的入组患者筛选,良好的侧支循环代偿,对合并动脉粥样硬化性原发狭窄的患者行个体化治疗,严格控制术后高血糖可改善血管内治疗的临床预后。
Objective Investigate the causes of poor prognosis of mechanical thrombectomy in the time window of acute ischemic stroke (AIS) with anterior circulation. Methods A retrospective analysis was made on the data of 78 patients with anterior circulation AIS who underwent mechanical thrombectomy in the time window from January 2017 to December 2017 in the Department of Vascular Neurosurgery of Liaocheng Brain Hospital. The modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 3 months after operation. According to the prognosis,the patients were divided into the group with good prognosis (42 cases, mRS<2 points) and the group with poor prognosis (36 cases, mRS<3 points). Univariate and multivariate Logistic regression analysis was used to analyze the related factors of poor prognosis. Results (1) Univariate analysis showed that the prognosis of patients with good combination and primary stenosis of diabetes mellitus and atherosclerosis was lower than that of patients with poor prognosis (P<0.05). The collateral circulation compensation rate and vascular recanalization rate of patients with good prognosis were higher than those of patients with poor prognosis (P<0.05). Learning significance (P<0.05).(2) Multivariate analysis showed that diabetes mellitus (P=0.035), collateral circulation compensation (P=0.011) and primary atherosclerotic stenosis (P=0.042) were independent risk factors for poor prognosis. Conclusion Perfect preoperative evaluation and strict screening of patients, good collateral circulation compensation,individualized treatment for patients with primary atherosclerotic stenosis,and strict control of postoperative hyperglycemia can improve the clinical prognosis of endovascular therapy.
作者
张萌
崔庆轲
林凯
郝继恒
王子栋
陈文伙
温昌明
代高磊
王继跃
刘卫东
王石雷
张利勇
Zhang Meng;Cui Qingke;Lin Kai;Hao Jiheng;Wang Zidong;Chen Wenhuo;Wen Changming;Dai Gaolei;Wang Jiyue;Liu Weidong;Wang Shilei;Zhang Liyong(Department of Vasculary Neurosurger, Shandong Province, Liaocheng Brain Hospital, Liaocheng 252000,China;Department of Neurology, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou 363000,China;Department of Neurology, Henan Province, Nanyang City Center Hospital, Nanyang 473000,China;Department of Intervention Center, Shandong Province, Liaocheng Brain Hospital, Liaocheng 252000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第25期1976-1980,共5页
National Medical Journal of China
基金
中国急性大血管闭塞性缺血性卒中直接动脉治疗的疗效评估:一个前瞻性多中心随机对照研究(DIRECT-MT)(GN-2017R0011)
山东省医药卫生科技发展计划项目(2017WS220)
国家“十三五”科技支撑计划项目(2015BAI12B04).
关键词
脑梗死
取栓
动脉闭塞性疾病
动脉粥样硬化
预后
Brain infarction
Thrombectomy
Arterial occlusive diseases
Atherosclerosis
Prognosis