急性缺血性脑卒中患者行机械取栓的临床疗效及预后因素分析

Clinical Efficacy and Prognostic Factors of Mechanical Thrombectomy in Acute Ischemic Stroke

目的:探讨急性缺血性脑卒中(AIS)患者行机械取栓术治疗的临床效果,并分析患者预后的影响因素。方法:选择萍乡矿业集团有限责任公司总医院2019年5月-2021年4月收治的92例AIS患者为研究对象,所有患者入院后在对症治疗基础上行机械取栓术,并于入院时、治疗后24 h、7 d、90 d采用美国国立卫生研究院卒中量表(NIHSS)评估患者神经功能变化,治疗90 d后使用改良Rankin量表(mRS)评估患者预后,同时分析影响预后的危险因素。结果:治疗后24 h、7 d、90 d,92例患者NIHSS评分逐渐降低,差异有统计学意义(P<0.05)。治疗后90 d,预后良好(mRS≤2分)59例(64.13%),预后不良(mRS≥3分)33例(35.87%)。预后良好患者与预后不良患者的年龄、高血压、糖尿病、术前血糖、收缩压、舒张压、侧支循环建立、开始治疗时间、血管再通时间、入院NIHSS评分比较,差异均有统计学意义(P<0.05)。经多因素logistic回归分析显示,年龄≥60岁、入院NIHSS评分≥14分、血管再通时间≥4 h、侧支循环未建立、高血压是导致患者预后不良的独立危险因素(P<0.05)。结论:AIS患者行机械取栓术治疗能明显改善神经功能,年龄≥60岁、高血压、侧支循环未建立、血管再通时间≥4 h、入院NIHSS评分≥14分是影响患者预后的独立危险因素。

Objective:To investigate the clinical efficacy of mechanical thrombectomy in patients with acute ischemic stroke(AIS),and to analyze the influencing factors of prognosis.Method:A total of 92 patients with AIS treated in Pingxiang Mining Industry Group Co.,Ltd.General Hospital from May 2019 to April 2021 were selected as the research objects.After admission,mechanical thrombectomy was performed on the basis of symptomatic treatment.The changes of neurological function were evaluated by national institutes of health stroke scale(NIHSS)at admission,24 hours,7 days and 90 days after treatment.After 90 days of treatment,the prognosis was evaluated by modified Rankin scale(mRS),at the same time,the risk factors affecting the prognosis were analyzed.Result:The NIHSS scores of 92 patients decreased gradually 24 hours,7 days and 90 days after treatment,the difference was statistically significant(P<0.05).90 days after treatment,59 cases(64.13%)had a good prognosis(mRS≤2 points)and 33 cases(35.87%)had a poor prognosis(mRS≥3 points).There were significant differences in age,hypertension,diabetes,preoperative blood glucose,systolic blood pressure,diastolic blood pressure,establishment of collateral circulation,starting treatment time,blood vessel recanalization time and admission NIHSS score between the patients with good prognosis and those with poor prognosis(P<0.05).Multivariate logistic regression analysis showed that age≥60 years old,NIHSS score≥14 points,vascular recanalization time≥4 h,no establishment of collateral circulation and hypertension were independent risk factors leading to poor prognosis(P<0.05).Conclusion:Mechanical thrombectomy can significantly improve neurological function in patients with AIS.Age≥60 years old,hypertension,failure of collateral circulation,vascular recanalization time≥4 h and NIHSS score≥14 are independent risk factors affecting the prognosis of patients.