急性脑梗死患者机械取栓治疗后HT和转归不良的发生情况及危险因素分析

Analysis of Incidence and Risk Factors of Adverse HT and Prognosis in Patients with Acute Cerebral Infarction After Mechanical Thrombolysis

目的:分析急性脑梗死患者机械取栓治疗后出血性转化(HT)和转归不良的发生情况及危险因素。方法:回顾性分析我院2019年1月至2020年1月收治的80例急性脑梗死患者的临床资料,患者发病90d时均采用改良Rankin量表(mRS)进行临床转归评估。根据HT的发生情况,分为HT组和无HT组;按照mRS评分,分为转归良好组和转归不良组。采用多变量Logistic回归分析影响患者转归不良和HT发生的独立危险因素。结果:HT组的性别、糖尿病史、心房颤动史、空腹血糖、穿刺至血管再通时间、取栓次数、取栓后mTICI分级与无HT组比较,差异存在统计学意义(P<0.05)。以上述因素作为自变量,以HT作为因变量进行多因素Logistic回归分析,结果显示,心房颤动、穿刺至血管再通时间、取栓次数、取栓后mTICI分级是导致急性脑梗死患者在机械取栓后出现HT的独立危险因素(P<0.05)。转归良好组和转归不良组患者在糖尿病史、心房颤动、基线美国国立卫生研究院卒中量表(NIHSS)评分、大脑中动脉闭塞血管、椎基底动脉闭塞血管、前循环卒中、HT及脑实质血肿方面的比较,具有统计学意义(P<0.05)。以上述因素作为自变量,以转归作为因变量进行多因素Logistic回归分析,结果显示伴有糖尿病史、基线NIHSS评分、存在脑实质血肿均是导致急性脑梗死患者在机械取栓后出现转归不良的独立影响因素(P<0.05)。结论:并发脑实质血肿和基线NIHSS评分过高、糖尿病均是急性脑梗死患者机械取栓治疗后出现不良转归的独立危险因素,而心房颤动则是出现HT的独立危险因素。

Objective:To analyze the occurrence and risk factors of hemorrhagic transformation(HT)and poor outcome in patients with acute cerebral infarction after mechanical thrombectomy.Methods:The clinical data of 80 patients with acute cerebral infarction admitted to our hospital from January 2019 to January 2020 were retrospectively analyzed.The modified Rankin Scale(mRS)was used to evaluate the clinical outcome of the patients 90 days after the onset of the disease.According to the occurrence of HT,they were divided into HT group and non-HT group;according to mRS score,they were divided into good outcome group and poor outcome group.Multivariate logistic regression analysis was used to analyze the independent risk factors that affect patients'poor outcome and HT.Results:The gender,history of diabetes,history of atrial fibrillation,fasting blood glucose,time from puncture to recanalization,number of thrombectomy,mTICI grade after thrombectomy were compared between the HT group and the non-HT group with statistically significant differences(P<0.05).Using the above factors as independent variables and HT as the dependent variable for multivariate logistic regression analysis,the results showed that atrial fibrillation,the time from puncture to recanalization,the number of thrombectomy times,and the mTICI grade after thrombectomy were the independent risk factors for HT after embolization(P<0.05)that led to mechanical retrieval in patients with acute cerebral infarction.Patients in the good outcome group and the poor outcome group have history of diabetes,atrial fibrillation,baseline National Institutes of Health Stroke Scale(NIHSS)score,middle cerebral artery occlusion vessel,vertebrobasilar artery occlusion vessel,anterior circulation stroke,HT and brain The comparison of parenchymal hematoma was statistically significant(P<0.05).Multivariate logistic regression analysis with the above factors as independent variables and poor outcome as the dependent variable showed that diabetes,baseline NIHSS score,and cerebral parenchymal hematoma were all independent factors that caused poor outcomes in patients with acute cerebral infarction after mechanical thrombectomy(P<0.05).Conclusion:Complicated brain parenchymal hematoma,high baseline NIHSS score,and diabetes are independent risk factors for adverse outcomes in patients with acute cerebral infarction after mechanical thrombectomy,while atrial fibrillation is an independent risk factor for HT.