血管内介入治疗后循环梗死预后及影响因素研究

Study of prognosis and influencing factors of circulatory infarction after intravascular intervention

目的探讨后循环梗死血管内介入治疗预后及其影响因素。方法方法连续选取我科收治2017年10月-2019年10月两年间住院治疗总共42例经临床确诊后循环梗死患者,记录患者性别、年龄、入院时主要症状与体征,发病危险因素,发病至就诊时时间间隔,发病至血管开通时间,病变血管部位,侧枝代偿,手术方法选择及血管再通情况,血管介入治疗前及术后7 d的NIHSS评分、GCS评分,出院时mRS评分,术后并发症及90 d预后。根据患者90 d预后改良的Rankin评分,分为良好预后组(mRS评分<4分)和不良预后组(mRS评分≧4分),并进行统计学分析。结果(1)后循环梗死采用多种介入治疗方法病变血管开通率达71.4%,后循环梗死3 m死亡率28.6%,良好预后率达50%。(2)单因素分析提示合并吸烟的患者预后不良(P<0.01)有明显统计学差异。(3)Logistic回归分析结果显示,在校正了吸烟等脑血管危险因素后,基底动脉下段闭塞与不良预后有关。(4)术中病变血管的良好再通(Ⅱb级或Ⅲ级)与良好预后成正相关。结论血管内介入治疗是后循环梗死高效快速开通血管方法,术中病变血管的良好再通与良好预后成正相关,吸烟和基底动脉下段闭塞与不良预后有关。

Objective To investigate the prognosis and influencing factors of intravascular interventional therapy for posterior circulation infarction.Method For selecting our department admitted in October 2019 and October 2017-two years hospitalized with a total of 42 cases of clinically diagnosed patients with posterior circulation infarction,patient gender,age,on admission,the main symptoms and signs,pathogenic factors,pathogenesis time interval,when to see a doctor to vascular disease opening time,lesion blood vessel parts,collateral compensatory,operation method choice and recanalization,vascular interventional treatment and postoperative 7 days before the NIHSS score,GCS score,mRS score when discharged from hospital,postoperative complications and prognosis of 90 days.According to the improved Rankin score of patients with 90-day prognosis,the patients were divided into a good prognosis group(mRS score<4 points)and a poor prognosis group(mRS score≥4 points),and statistical analysis was conducted.Results(1)For posterior circulation infarction,multiple interventional therapies were used to treat the lesion vessel opening rate of 71.4%,the 3-month mortality rate of posterior circulation infarction was 28.6%.And the good prognosis rate was 50%.(2)Univariate analysis suggested a statistically significant difference in the prognosis of patients with smoking P<0.01).(3)Logistic regression analysis showed that after adjusting for cerebrovascular risk factors such as smoking,lower basilar artery occlusion was associated with poor prognosis.(4)Good intraoperative lesion vessels(Ⅱb level orⅢlevel)and is related to good prognosis.Conclusion Endovascular interventional therapy is an efficient and rapid method for posterior circulation infarction to open blood vessels.Good recanalization of diseased blood vessels during operation is positively correlated with good prognosis,while smoking and lower basilar artery occlusion are correlated with poor prognosis.