发病4.5小时内老年急性脑梗死接受介入治疗的预后分析

Prognostic analysis of elderly patients with acute cerebral infarction receiving interventional therapy within 4.5 hours after onset

目的:研究发病4.5h内老年急性脑梗死接受介入治疗的预后分析。方法:选取我院2018年1月至2020年1月,收治的74例老年急性脑梗死患者,根据治疗方法分为对照组(直接取栓,n=34)和观察组(桥接治疗,n=40)。分析两组年龄、性别、入院时美国国立卫生研究院卒中量表(NIHSS)评分、血管内治疗方案等一般资料,对比两组临床疗效(血管再通率、支架取栓次数≥3次所占比、不同抢救治疗所占比),比较两组并发症发生率及预后,多因素Logistic回归分析法分析发病4.5 h内老年急性脑梗死患者治疗后90 d内预后的影响因素。结果:两组年龄、性别、入院时NIHSS评分、血压、既往史、闭塞血管、血管内治疗方案及穿刺至血管再通时间≤1 h所占比比较,差异无统计学意义(P> 0.05);观察组发病至腹股沟穿刺时间≤4 h所占比低于对照组(P <0.05)。两组血管再通率、支架取栓次数≥3次及不同抢救治疗方案所占比,差异无统计学意义(P> 0.05)。观察组并发症发生率为45.0%,较对照组的38.23%,差异无统计学意义(P> 0.05)。两组治疗后30 d内预后良好率及7 d、30 d、90 d内死亡率,差异无统计学意义(P> 0.05);观察组血管内治疗后24 h神经功能改善率为50.0%、治疗后90 d内预后良好率为75.0%,高于对照组的26.5%、52.9%(P <0.05)。多因素Logistic回归分析显示,发病至腹股沟穿刺时间≤4 h(OR=5.741,95%CI:1.189~11.712)是发病4.5 h内老年急性脑梗死患者治疗后90 d内预后良好的保护因素(P <0.05)。结论:发病4.5 h内的老年急性脑梗死患者采用桥接治疗与直接取栓治疗效果相当,不会引起严重并发症,但桥接治疗后90d内的预后效果优于直接取栓,此时要注意发病至腹股沟穿刺时间需≤4 h,若无法保障在该时间内进行桥接治疗,则可选择直接取栓治疗。

Objective: To study the prognosis of elderly patients with acute cerebral infarction receiving interventional therapy within 4.5H after onset. Methods: A total of 74 elderly patients with acute cerebral infarction admitted to Beijing Shunyi Hospital from January 2018 to January 2020 were selected and divided into control group(direct thrombus removal, n=34) and observation group(bridging therapy, n=40)according to treatment methods. Statistics of age, gender, National Institutes of Health Stroke Scale(NIHSS) score at admission, endovascular treatment plan and other general data of the two groups were collected, and the clinical efficacy of the two groups was compared(vascular recanalization rate, number of stent removals ≥ 3 times accounted for Ratio, the proportion of different rescue treatment), compare the complication rate and prognosis of the two groups, multivariate logistic regression analysis method to analyze the factors affecting the prognosis of elderly patients with acute cerebral infarction within 4.5 hours of onset and 90days after treatment. Results: There was no significant difference between the two groups in age, gender,NIHSS score at admission, blood pressure, past history, vascular occlusion, endovascular treatment plan, and the proportion of puncture to recanalization time ≤ 1h(P>0.05);The proportion of the time from onset to inguinal puncture ≤ 4 hours in the group was lower than that in the control group(P < 0.05). There was no significant difference between the two groups in the rate of vessel recanalization, the number of stent removal times ≥ 3 times, and the proportion of different rescue treatment plans(P>0.05),The incidence of complications in the observation group was 45.0%, which was not statistically different from 38.2% in the control group(P>0.05). There was no significant difference in the good prognosis rate within 30 days and the mortality within 7 days, 30 days, and 90 days between the two groups after treatment(P>0.05);the improvement rate of neurological function in the observation group was 50.0%, 24 hours after endovascular treatment. The good prognosis rate within 90 days after treatment was 75.0%, which was higher than 26.5%and 52.9% in the control group(P<0.05). Multivariate Logistic regression analysis showed that the time from onset to inguinal puncture ≤ 4 h(OR=5.741, 95%CI:1.189-11.712) was a protective factor for the good prognosis of elderly patients with acute cerebral infarction within 4.5 hours after treatment(P<0.05).Conclusions: The effect of bridging therapy in elderly patients with acute cerebral infarction within 4.5 hours of onset is equivalent to that of direct thrombectomy, and will not cause serious complications. However, the prognostic effect within 90 days after bridging therapy is better than that of direct thrombectomy. At this time,attention should be paid to the onset of the disease. It takes ≤ 4 hours to puncture the groin. If the bridging treatment cannot be guaranteed within this time, you can choose direct thrombus removal treatment.