急性大动脉闭塞性脑梗死支架取栓后脑水肿危险因素和预后分析

Analysis of Risk Factors and Prognosis of Cerebral Edema after Stent Thrombectomy in Acute Cerebral Infarction with Large Artery Occlusion

目的:探讨急性大动脉闭塞性脑梗死支架取栓后脑水肿发生的危险因素以及脑水肿对神经预后的影响。方法:回顾性选择2018-02-2019-12本院神经内科收治的181例早期行支架取栓血管再通成功的急性大动脉闭塞性脑梗死患者,根据取栓后是否发生脑水肿将其分为脑水肿组(n=27)和无脑水肿组(n=154)。收集患者基线资料和围手术期数据,随访患者神经预后情况,分析影响急性大动脉闭塞性脑梗死患者支架取栓后发生脑水肿的危险因素以及脑水肿对神经预后的影响。结果:与无脑水肿组比较,脑水肿组年龄较大(P<0.05),房颤病史比例、大面积梗死比例、术后脑出血转化比例、术前NIHSS评分、术后ASITN/SIR分级0-1级比例、TICI分级Ⅰ-Ⅱ级比例、术前FPG、白细胞计数增高(P<0.05或P<0.01),发病至手术时间、发病至血管再通时间较长(P<0.01),取栓次数较多(P<0.01)。Logistic回归分析结果显示房颤病史(OR=1.749,95%CI:1.623-1.895)、术后脑出血转化(OR=1.844,95%CI:1.732-1.931)、术后ASITN/SIR分级低(OR=2.298,95%CI:2.105-2.356)、发病至血管再通时间长(OR=2.004,95%CI:1.905-2.187)是急性大动脉闭塞性脑梗死支架取栓后发生脑水肿的危险因素(P<0.01)。脑水肿组预后不良发生率高于无脑水肿组(P<0.05)。结论:急性大动脉闭塞性脑梗死支架取栓后脑水肿发生率高,脑水肿的发生可恶化患者神经预后。临床应警惕有房颤病史、术后发生脑出血转化和侧支循环不良患者,尽量缩短发病至血管再通时间。

Objective:To investigate the risk factors and prognosis of cerebral edema after stent implantation in acute cerebral infarction with major artery occlusion.Method:From February 2018 to December 2019,181 patients with acute arterial occlusive cerebral infarction were retrospectively selected.According to whether cerebral edema occurred after thrombectomy,they were divided into cerebral edema group(n=27)and no cerebral edema group(n=154).Baseline data,perioperative data were collected,and neurological prognosis was followed up.The risk factors for cerebral edema after stent implantation in patients with acute cerebral infarction with major artery occlusion and the influence of cerebral edema on neurological prognosis were analyzed.Results:Compared with the group without cerebral edema,the age of the cerebral edema group was higher(P<0.05),history of atrial fibrillation,large area of infarction,postoperative hemorrhage transformation,preoperative NIHSS score,postoperative ASITN/SIR class 0 to 1,proportion of TICI classⅠ-Ⅱ,preoperative FPG,white blood cell count were higher(P<0.05).The time from onset to operation,the time from onset to recanalization in the cerebral edema group was longer(P<0.05),and the number of thrombectomy was higher(P<0.05).Logistic regression analysis results showed that history of atrial fibrillation,postoperative cerebral hemorrhage transformation,low postoperative ASITN/SIR grade,high preoperative FPG,high preoperative white blood cell count,and long time from onset to recanalization were risk factors for cerebral edema after stent thrombectomy in acute cerebral infarction with large artery occlusion(P<0.01).Logistic regression analysis results showed that history of atrial fibrillation(OR=1.749,95%CI:1.623-1.895),postoperative cerebral hemorrhage transformation(OR=1.844,95%CI:1.732-1.931),low postoperative ASITN/SIR grade(OR=2.298,95%CI:2.105-2.356),and long time from onset to recanalization(OR=2.004,95%CI:1.905-2.187)were risk factors for cerebral edema after stent thrombectomy in acute cerebral infarction with large artery occlusion(P<0.01).The incidence of poor prognosis in the cerebral edema group was higher than that in the non-cerebral edema group(P<0.05).Conclusion:The incidence of cerebral edema after stent thrombectomy in acute cerebral infarction with large artery occlusion is high,and the occurrence of cerebral edema may worsen the neurological prognosis of patients.Patients with a history of atrial fibrillation,postoperative intracerebral hemorrhage transformation and poor collateral circulation should be kept on alert clinically,and the time from onset to recanalization should be minimized.