基于经颅多普勒超声构建模型预测急性前循环大血管闭塞机械取栓术后神经功能预后

Transcranial Doppler-based model in predicting neurological function after intra-arterial mechanical thrombectomy for acute anterior circulation large vessel occlusion

目的 探讨基于经颅多普勒超声(TCD)构建模型预测急性前循环大血管闭塞(aLVO)机械取栓术后神经功能预后。方法 收集2020年6月至2021年3月福建医科大学附属漳州市医院收治的44例单侧aLVO机械取栓术后血管再通患者的临床资料,均应用TCD测量术后双侧大脑中动脉(MCA)血流,同时记录患者临床情况,术后90 d应用改良Rankin量表(mRS)评估神经功能预后。采用单因素分析和多元广义线性回归分析筛选与神经功能预后独立关联的变量,同时建立预测模型并用bootstrap法验证。结果 单因素分析结果显示,年龄、MCA峰值流速差异比值、MCA峰值流速差异比值、发病至血管再通时间、术后收缩压均与术后90 d mRS评分有关(P<0.20)。多元广义线性回归分析结果显示,MCA血流峰值流速差异比值、发病至血管再通时间均与术后90 d mRS评分独立相关(P<0.20),建立模型0.91+1.37×X1(发病至再通时间,>240 min=1,<240 min=0)+3.43×X2(MCA峰值流速差异比值)。bootstrap验证结果显示,多元广义线性回归结果构建模型的各变量回归系数均落在95%CI内。结论 MCA峰值流速差异比值、发病至血管再通时间与aLVO患者机械取栓术后神经功能有关,可应用TCD对a LVO患者术后的颅内血流进行监测并建立预测模型预估术后90 d mRS评分,指导aLVO患者术后MCA血流调控,改善其远期预后。

Objective To explore the transcranial Doppler(TCD) based model in predicting neurological function after intra-arterial mechanical thrombectomy for acute anterior circulation large vessel occlusion(aLVO). Method The clinical data of 44 patients with vascular recanalization after unilateral aLVO mechanical thrombectomy admitted to Zhangzhou Hospital Affiliated to Fujian Medical University from June 2020 to March 2021 were selected. TCD was performed to obtain peak flow velocity of middle cerebral artery(MCA) after operation, the clinical indexes were recorded. All patients were evaluated by modified Rankin scale(mRS) to assess neurological function 90days after operation. Univariate analysis and multiple linear regression analysis were used to screen the factors closely associated with neurological function prognosis, and the model was established and validated by using the bootstrap method. Result Univariate analysis showed that age, peak flow velocity difference ratio, time from onset to reperfusion, time from onset to revascularization and postoperative systolic pressure were closely related to mRS score 90 days after operation(P<0.20). Further multiple generalized linear regression analysis showed that the difference ratio of MCA peak flow velocity and the time from onset to vascular recanalization were independently correlated with the mRS score at 90 days after operation(P<0.20), and the model was 0.91+1.37×X1(time from onset to recanalization, >240 min=1, <240 min=0)+3.43×X2(MCA peak velocity difference ratio). The bootstrap validation results showed that the model of each variable regression coefficients felled within the 95%CI.Conclusion MCA peak flow velocity ratio and time from onset to revascularization are related to neurological function after intra-arterial mechanical thrombectomy for aLVO. The postoperative intracranial blood flow can be monitored by TCD in aLVO patients and the predict model can be established to predict the mRS 90 days after operation, and MCA blood flow can be regulated based on this to improve the long-term prognosis of aLVO patients.