急性颅内大动脉闭塞取栓后不良结局的影响因素分析

Analysis of impacting factors of adverse outcomes after embolectomy for acute intracranial arterial occlusion

目的探讨急性颅内大动脉闭塞患者经机械取栓后不良结局的影响因素。方法回顾性分析2019年1月至2020年4月在我院行SOLITAIRE支架系统支架取栓治疗急性颅内大动脉闭塞的患者76例,术后90 d采用改良的Rankin评分量表(mRS)评估患者的预后情况进行分组,mRS评分≤2分的42例患者列入预后良好组,mRS评分≥3分的34例患者列入预后不良组,采用Logistic回归进行分析。结果两组在年龄、高血压、糖尿病、入院时美国国立卫生研究院卒中量表(NIHSS)评分、术后NIHSS评分、闭塞的部位、侧支循环、取栓次数、血管再通例数上比较,差异有统计学意义(P<0.05),对危险因素进行Logisit回归分析,年龄、术后NIHSS评分、闭塞的部位、侧支循环不良、取栓次数>3次、血管再通不良是急性颅内大动脉闭塞取栓不良结局发生的独立危险因素(P<0.05)。结论年龄、术后NIHSS评分、闭塞的部位、侧支循环、取栓次数及血管再通情况是急性颅内大动脉闭塞患者预后不良的独立危险因素。

Objective To investigate the impacting factors of adverse outcomes after mechanical embolectomy in patients with acute intracranial arterial occlusion.Methods A total of 76 patients with acute intracranial arterial occlusion treated with SOLITAIRE stent system embolectomy and admitted to our hospital from January 2019 to April 2020 were retrospectively analyzed.90 days after operation,the modified Rankin scale(mRS)was used to evaluate the prognosis of patients.Patients with mRS score≤2 points were included in the good prognosis group(n=42),while those with mRS score≥3 points were included in the poor prognosis group(n=34).The data with difference between the two groups were analyzed by Logistic regression method.Results There are differences between the two groups in age,hypertension,diabetes,National Institutes of Health stroke scale(NIHSS)score at admission,NIHSS score after operation,occlusion site,collateral circulation,times of embolectomy and cases of vascular recanalization,with statistically significant differences(P<0.05).Logistic regression analysis was used to analyze the risk factors,and it showed that age,NIHSS score after operation,occlusion site,poor collateral circulation,times of embolectomy>3 times,and poor vascular recanalization were independent risk factors for adverse outcomes of embolectomy in acute intracranial arterial occlusion(P<0.05).Conclusion Age,NIHSS score after operation,occlusion site,collateral circulation,times of embolectomy and vascular recanalization are independent risk factors for poor prognosis in patients with acute intracranial arterial occlusion.