急性后循环脑梗死行血管内治疗短期预后的独立预测因素分析

Independent predictors of short-term prognosis after endovascular treatment for acute posterior circulation stroke

目的探讨急性后循环脑梗死行血管内治疗短期预后的独立预测因素。方法回顾性连续纳入南京市第一医院神经内科2015年5月至2019年9月收治的83例急性后循环脑梗死行血管内治疗(包括支架取栓、球囊扩张和支架置入等)患者,通过门诊或电话随访获得患者发病后90 d改良Rankin量表(mRS)评分。根据90 d mRS评分,将所有患者分为90 d预后良好(mRS评分0~2分)组38例,90 d预后不良(mRS评分3~6分)组45例,对两组患者间的基本资料及临床资料进行单因素分析,采用多因素Logistic回归分析影响血管内治疗短期预后的因素。结果单因素分析结果显示,预后良好组与预后不良组患者间既往糖尿病史患者比例[15.8%(6/38)比35.6%(12/45),χ^2=3.950]、基线美国国立卫生研究院卒中量表(NIHSS)评分[14.00(4.50,18.00)分比28.00(15.00,35.00)分,Z=17.028]、入院昏迷患者比例[10.5%(4/38)比57.8%(26/45),χ^2=2.146]及出血转化[5.3%(2/38)比22.2%(10/45),χ^2=4.086]、卒中相关肺炎发生率[47.4%(18/38)比84.4%(38/45),χ^2=11.755]差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果表明,卒中相关肺炎(OR=6.910,95%CI:1.973~24.209;P=0.003)、高基线NIHSS评分(OR=1.119,95%CI:1.059~1.182;P<0.01)与90 d预后不良显著相关。结论卒中相关肺炎和基线NIHSS评分是后循环脑梗死行血管内治疗患者90 d预后的独立预测因子,对于此类患者,需要重视卒中相关肺炎的预防和治疗以及基线NIHSS评估。

Objective To explore independent predictors of short-term prognosis after endovascular treatment for acute posterior circulation stroke.Methods From May 2015 to September 2019,83 patients with acute posterior circulation stroke and who underwent endovascular treatment(including stent-retrieval,balloon expansion and stent implantation,etc.)in the Department of Neurology,Nanjing First Hospital were enrolled in this study.According to the 90-day modified Rankin scale(mRS),38 patients were divided into the good prognosis group(mRS 0-2)and 45 patients into the poor prognosis group(mRS 3-6).Univariate analysis was performed on the baseline data and clinical data between two groups,and multivariate logistic regression analysis was used to analyze the independent factors affecting the short-term prognosis of endovascular treatment.Results Comparing the good prognosis group with the poor prognosis group,univariate analysis showed significant differences in proportion of patients with previous history of diabetes(15.8%[6/38]vs.35.6%[12/45],χ^2=3.950),baseline National Institutes of Health Stroke Scale(NIHSS)score(14.00[4.50,18.00]vs.28.00[15.00,35.00],Z=17.028),proportion of patients admitted to hospital with coma(10.5%[4/38]vs.57.8%[26/45],χ^2=2.146),hemorrhagic transformation(5.3%[2/38]vs.22.2%[10/45],χ^2=4.086)and stroke-related pneumonia(47.4%[18/38]vs.84.4%[38/45],χ^2=11.755)(all P<0.05).Multivariate Logistic regression analysis showed that stroke-associated pneumonia(OR,6.910,95%CI 1.973-24.209;P=0.003)and high baseline NIHSS score(OR,1.119,95%CI 1.059-1.182;P<0.01)were significantly associated with poor 90-day prognosis.Conclusions Stroke-associated pneumonia and baseline NIHSS score were independent predictors of 90-day prognosis after endovascular treatment in patients with acute posterior circulation stroke.For such patients,attention needs to be paid to prevention and treatment of stroke-associated pneumonia and baseline NIHSS assessment.