接受血管内治疗的急性脑梗死患者预后影响因素分析

Factors affecting prognosis of acute cerebral infarction patients receiving EVT

目的总结接受血管内治疗(EVT)的急性脑梗死患者的预后影响因素。方法接受EVT的急性脑梗死患者115例,术后3个月使用改良Rankin评分量表(mRS)评估患者预后情况,分为预后良好组(mRS评分为0~2分)和预后不良组(mRS评分为3~6分),收集并比较两组患者的性别、年龄、合并症(高血压、糖尿病或糖耐量异常、房颤、冠心病)、责任血管等一般资料,治疗方法(支架取栓、动脉溶栓、抽吸取栓、桥接治疗、球囊扩张或支架置入、替罗非班局部给药)、发病至股动脉穿刺时间(OPT)、EVT操作时间、取栓次数、血管再通率、出血转化发生率、术前NIHSS评分、术后24 h NIHSS评分、NIHSS评分变化量(ΔNIHSS)、发病0~6 h的中性粒细胞与淋巴细胞计数比值(NLR)(NLR_(T0))、发病6~24 h的NLR(NLRT1)及NLR变化量等EVT相关指标,有无肺炎、严重脑水肿、脑积水、应激性溃疡、甲亢危象、泌尿系感染、心跳呼吸骤停、继发性癫痫等术后并发症及有创机械通气、接受去骨瓣减压或血肿穿刺引流和院内死亡的治疗及转归资料。结果预后不良组女性比例、年龄、EVT操作时间、取栓次数、术前NIHSS评分、术后24 h NIHSS评分、ΔNIHSS评分、NLRT1及发生肺炎、有创机械通气、严重脑水肿等资料与预后良好组相比,P均<0.05。年龄、有创机械通气、严重脑水肿和术后24 h NIHSS评分是接受EVT的急性脑梗死患者的预后影响因素。结论年龄大、接受有创机械通气治疗、术后出现严重脑水肿和术后24 h NIHSS评分高是接受EVT的急性脑梗死患者预后的危险因素。

Objective To summarize the factors affecting progosis of actue cerebral infarction patients receiving en-dovascular therapy(EVT).Methods A total of 115 patients with acute cerebral infarction who received EVT were divid-ed into good prognosis group(modified Rankin scale scole of 0-2 points)and poor prognosis group modified Rankin scale scole of 3-6 based on the prognosis of patients 3 months after operation.General data such as gender,age,complications(hypertension,diabetes or glucose tolerance disorder,atrial fibrillation,coronary heart disease),and responsible blood vessels of the patients in two groups were collected and compared.Treatment methods(stent thrombectomy,arterial throm-bolysis,suction thrombosis,bridging therapy,balloon dilation or stent implantation,local use of tirofiban),time from on-set to femoral artery puncture(OPT),EVT operation time,times of thrombectomy,vascular recanalization rate,incidence of hemorrhagic transformation,preoperative NIHSS score,NIHSS score 24 h after EVT,NIHSS score change(ΔNIHSS),neutrophil-lymphocyte count ratio(NLR_(T0))0-6 h after onset,NLR(NLRT1)6-24 h after onset and NLR change and other EVT-related indicators of the patients in two groups were collected and compared.Postoperative complications such as pneumonia,severe cerebral edema,hydrocephalus,stress ulcer,hyperthyroidism crisis,urinary tract infection,cardiac and respiratory arrest,secondary epilepsy.Treatment and outcome data of invasive mechanical ventilation,decompression of bone flap-removal,hematoma puncture and drainage and nosocomial of the patients in two groups were collected and compared.Results The proportion of women,age,EVT operation time,times of thrombectomy,preoperative NIHSS score,24 h postoperative NIHSS score,ΔNIHSS score,NLRT1,pneumonia,invasive mechanical ventilation and severe brain edema in the poor prognosis group were compared with those in the good prognosis group(all P<0.05).Age,inva-sive mechanical ventilation,severe cerebral edema,and NIHSS score 24 h after EVT were prognostic factors in patients with acute cerebral infarction receiving EVT.Conclusion Older age,invasive mechanical ventilation,severe postopera-tive cerebral edema,and high NIHSS score 24 h after EVT are risk factors for prognosis of patients with acute cerebral in-farction receiving EVT.