急性大脑中动脉闭塞性脑梗死血管内介入治疗预后的影响因素

Influencing factors of outcomes after endovascular intervention for acute middle cerebral artery occlusive cerebral infarction

目的探讨急性大脑中动脉闭塞性脑梗死血管内介入治疗预后的影响因素。方法选取2020年1月至2021年12月于粤北人民医院神经内科接受血管内介入治疗的62例急性大脑中动脉闭塞性脑梗死患者作为研究对象,于术后随访90 d,依据改良Rankin量表(mRS)评分将其分为预后良好组(n=47,mRS评分≤2分)与预后不良组(n=15,mRS评分≥3分);收集两组患者的年龄、性别等一般资料,运用多因素logistic回归分析模型分析急性大脑中动脉闭塞性脑梗死患者经血管内介入治疗后预后的影响因素。结果单因素分析结果显示,性别、体重指数(BMI)、复合再通方法与急性大脑中动脉闭塞性脑梗死患者血管内介入治疗预后无关,差异无统计学意义(P>0.05);年龄、有无脑水肿、术前美国国立卫生研究院卒中量表(NIHSS)评分、糖尿病史与患者血管内介入治疗预后有关,差异有统计学意义(P<0.05)。logistic回归模型进行多因素分析结果显示,年龄≥60岁(β=2.773,OR=16.000,95%CI=3.713~68.955)、有脑水肿(β=2.942,OR=18.958,95%CI=3.727~96.441)、术前NIHSS评分≥15分(β=2.320,OR=10.175,95%CI=2.662~38.887)、有糖尿病史(β=2.320,OR=10.175,95%CI=2.662~38.887)是急性大脑中动脉闭塞性脑梗死患者血管内介入治疗后预后的独立危险因素(P<0.05)。结论急性大脑中动脉闭塞性脑梗死患者经血管内介入治疗后预后不良的因素具有多样性,如年龄≥60岁、有脑水肿、术前NIHSS评分≥15分、有糖尿病史,临床需对此种情况予以高度重视。

Objective To investigate the influencing factors of outcomes after endovascular intervention for acute middle cerebral artery occlusive cerebral infarction.Methods A total of 62 patients with acute middle cerebral artery occlusive cerebral infarction who received endovascular intervention therapy in the Department of Neurology of Yue Bei People's Hospital from January 2020 to December 2021 were selected as research objects.After 90 days of follow-up,the patients were divided into good prognosis group(n=47,mRS score≤2)and poor prognosis group(n=15,mRS score≥3)according to the modified Rankin scale(mRS)score.The general data such as age and sex of the two groups of patients were collected and the influencing factors of the prognosis of patients with acute middle cerebral artery occlusion cerebral infarction after intravascular intervention treatment with multivariate logistic regression analysis model were analyzed.Results Univariate analysis showed that sex,body mass index(BMI)and composite recanalization method were not significantly related to the prognosis of patients with acute middle cerebral artery occlusion(MCAO)after endovascular intervention(P>0.05).Age,presence or absence of brain edema,preoperative National Institute of Health stroke scale(NIHSS)score,and history of diabetes were related to the prognosis of patients undergoing endovascular intervention,and the differences were statistically significant(P<0.05).Multivariate analysis of logistic regression model showed that age≥60 years old(β=2.773,OR=16.000,95%CI=3.713-68.955),with cerebral edema(β=2.942,OR=18.958,95%CI=3.727-96.441),preoperative NIHSS score≥15 points(β=2.320,OR=10.175,95%CI=2.662-38.887),history of diabetes(β=2.320,OR=10.175,95%CI=2.662-38.887)were independent risk factors for the prognosis of patients with acute middle cerebral artery occlusion cerebral infarction after endovascular intervention therapy(P<0.05).Conclusion The factors of poor prognosis in patients with acute middle cerebral artery occlusion cerebral infarction after endovascular intervention treatment are diverse,such as age≥60 years old,cerebral edema,preoperative NIHSS score≥15 points and history of diabetes.Clinical attention should be paid to this situation.