不同血糖状态下急性缺血性脑卒中患者机械取栓术的预后情况观察

Prognostic observation of mechanical thrombectomy in patients with acute ischemic stroke under different blood glucose status

目的 探讨不同血糖状态下急性缺血性脑卒中患者机械取栓术的预后情况。方法 选择2021年1—12月在本院接受机械取栓的70例急性脑卒中患者作为研究对象,根据入院随机血糖的不同,将患者分为高血糖组(血糖>6.1 mmol/L,33例)和正常血糖组(血糖≤6.1 mmol/L,37例)两组。两组患者均接受机械取栓治疗,应用美国国立卫生院卒中量表(NIHSS)评价患者取栓后神经功能情况,记录取栓术后症状性颅内出血和颅内出血的发生例数,并应用改良Rankin评分评价患者预后情况。结果 取栓术后14天和30天时,两组患者NIHSS评分呈显著性下降趋势,并且正常血糖组两时间点NIHSS评分均低于高血糖组,差异有统计学意义(P<0.05);取栓术后30天内,正常血糖组患者症状性颅内出血发生率(0例,0%)和颅内出血发生率(1例,4.76%)均低于高血糖组(分别为17.95%和23.08%),差异有统计学意义(P<0.05);取栓术后90天时,正常血糖组患者预后良好占比(29例,78.38%)高于高血糖组(18例,54.55%),差异有统计学意义(P<0.05)。结论 急性缺血性脑卒中患者术前高血糖状态会影响机械取栓术后神经功能改善,增加出血转化的发生风险,临床预后较差。

Objective To investigate the prognosis of patients with acute ischemic stroke under different blood glucose status after mechanical thrombectomy.Methods A total of 70 patients with acute stroke who received mechanical thrombectomy in the first hospital of Qiqihar city from January 2021 to December 2021 were selected as the subjects.According to blood glucose level at admission,the subjects were divided into the hyperglycemia group(blood glucose>6.1 mmol/L,33 cases) and the normal blood glucose group(blood glucose≤6.1 mmol/L,37 cases).Patients in both two groups received mechanical thrombectomy.The neurological function of the patients was evaluated by the National institutes of health stroke scale(NIHSS) after thrombolectomy;the numbers of symptomatic intracranial hemorrhage and intracranial hemorrhage were recorded after thrombolectomy,and the prognosis of the patients was evaluated by the modified Rankin score.Results At 14th d and 30th d after thrombolysis,NIHSS scores of the two groups showed a significant downward trend,and NIHSS scores of the normal blood glucose group were significantly lower than those of the hyperglycemia group at both time points(P<0.05).Within 30 days after thrombectomy,the incidence of symptomatic intracranial hemorrhage(0 cases,0%) and intracranial hemorrhage(1 case,4.76%) in normal blood glucose group were significantly lower than those in hyperglycemia group(17.95% and 23.08%,respectively)(P<0.05).At 90th d after thrombectomy,the proportion of good prognosis in the normal blood glucose group(29 cases,78.38%) was significantly higher than that(18 cases,54.55%) in hyperglycemia group(P<0.05).Conclusions Preoperative hyperglycemia in patients with acute ischemic stroke could affect the improvement of neurological function after mechanical thrombectomy and increase the risk of hemorrhage transformation,resulting in poor clinical prognosis.