机械取栓治疗大血管闭塞性急性缺血性脑卒中预后不良的影响因素

Influencing factors of poor prognosis of mechanical thrombectomy in patients with acute ischemic stroke due to large vessel occlusion

目的探讨机械取栓治疗大血管闭塞性急性缺血性脑卒中(AIS)预后不良的影响因素。方法回顾性分析2018年2月至2020年2月本院收治并行机械取栓治疗的72例大血管闭塞性AIS患者的临床资料,按照mRS量表分为预后不良组(mRS评分0~2分,n=29)与预后良好组(mRS评分3~5分,n=43)。两组均行机械取栓治疗,比较两组临床资料、临床特征、实验室指标,采用Logistic回归分析大血管闭塞性AIS预后不良的影响因素。结果两组性别、年龄、闭塞部位、高血压、糖尿病、心房颤动、侧支循环、吸烟及饮酒比较差异无统计学意义;预后不良组串联病变占比高于预后良好组,差异有统计学意义(P<0.05)。两组红细胞(RBC)、白细胞计数(WBC)、中性粒细胞与淋巴细胞比值(NLR)比较差异无统计学意义。预后不良组术前ASPECT评分、血管再通分级均低于对照组,入院到血管再通时间长于对照组,差异有统计学意义(P<0.05)。经Logistic回归分析结果显示,串联病变、术前ASPECT评分、入院到血管再通时间、血管再通分级均为大血管闭塞性AIS预后不良的影响因素(P<0.05)。结论串联病变、术前ASPECT评分、入院到血管再通时间、血管再通分级均为机械取栓治疗大血管闭塞性AIS预后不良的影响因素,可作为评估预后的临床依据。

Objective To investigate the Influencing factors of poor prognosis of mechanical thrombectomy in patients with acute ischemic stroke(AIS)due to large vessel occlusion.Methods The clinical data of 72 AIS patients with large vessel occlusion treated with mechanical thrombectomy in our hospital from February 2018 to February 2020 were retrospectively analyzed,they were divided into the poor prognosis group(mRS Score 0-2,n=29)and the good prognosis group(mRS Score 3-5,n=43)according to the mRS Scale.The two groups were treated with mechanical thrombectomy,the clinical data,clinical characteristics and laboratory indicators of the two groups were compared,and the influencing factors of poor prognosis of AIS with large vessel occlusion were analyzed by Logistic regression.Results There were no significant differences in gender,age,occlusive site,hypertension,diabetes,atrial fibrillation,collateral circulation,smoking and drinking between the two groups;The proportion of tandem lesions in poor prognosis group was higher than that in good prognosis group,and the difference was statistically significant(P<0.05).There were no significant differences in the red blood cell(RBC),white blood cell(WBC),and neutrophil to lymphocyte ratio(NLR)between the two groups;the preoperative ASPECT score and vascular recanalization grade of the poor prognosis group were lower than those of the control group,and the time from admission to vascular recanalization was longer than that of the control group,and the differences were statistically significant(P<0.05).The results of Logistic regression analysis showed that tandem lesions,preoperative ASPECT score,time from admission to vascular recanalization,and vascular recanalization grade were the influencing factors of poor prognosis of AIS with large vessel occlusion(P<0.05).Conclusion Tandem lesions,preoperative ASPECT score,time from admission to vascular recanalization and vascular recanalization grade are the influencing factors of poor prognosis in patients with large vessel occlusive AIS treated with mechanical thrombectomy,which can be used as the clinical basis for evaluating the prognosis.