急性后循环大血管闭塞血管内治疗预后影响因素分析

Analysis of prognostic factors of endovascular therapy for acute posterior circulation large vessel occlusion

目的研究影响急性后循环大血管闭塞血管内治疗预后的相关因素。方法回顾性分析2020年3月至2022年9月在海南医学院第二附属医院成功行血管内治疗的急性后循环大血管闭塞的54例住院患者的临床基本资料、手术资料及术后资料;采用改良Rankin量表(modified Rankin scale,mRS)评分评价患者预后状况,根据术后90d mRS评分分为预后良好组(0~3分)和预后不良组(4~6分),采用Logistic回归分析明确影响血管内治疗术后90d预后的危险因素。结果预后良好组22例(40.7%),预后不良组32例(59.3%);术后72h出现症状性颅内出血率9.3%,病死率33.3%。多因素Logistic回归分析显示入院时美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)(OR=1.091,95%CI:1.002~1.188,P=0.046)评分与良好预后呈负相关,后循环Alberta卒中项目早期CT评分(postcirculationAlberta stroke program early CT score,pc-ASPECTS)(OR=0.431,95%CI:0.207~0.896,P=0.024)与良好预后呈正相关,侧支循环(OR=0.228,95%CI:0.080~0.647,P=0.005)与良好预后呈正相关,在模型中均有统计学意义(P<0.05)。结论低入院NIHSS评分、高pc-ASPECTS、良好的侧支循环是预后良好的影响因素。

Objective To study the prognostic factors of endovascular therapy for acute posterior circulation large vessel occlusion.Methods The basic clinical,surgical and postoperative data of 54 inpatients with acute posterior circulation great vessel occlusion who underwent endovascular therapy in the Second Affiliated Hospital of Hainan Medical University from March 2020 to September 2022 were retrospectively analyzed.The improved modified Rankin scale(mRS)was used to evaluate the prognosis of the patients.The patients were divided into favorable prognosis group(0-3 points)and unfavorable prognosis group(4-6 points)according to mRS 90 days after surgery.Logistic regression analysis was used to identify the risk factors affecting the prognosis 90 days after intravascular therapy.Results There were 22 cases(40.7%)in the favorable prognosis group and 32 cases(59.3%)in the unfavorable prognosis group.The rate of symptomatic intracranial hemorrhage 72 hours after operation was 9.3%,and the fatality rate was 33.3%.Multivariate Logistic regression analysis:Results showed that National Institute of Health stroke scale(NIHSS)score on admission(OR=1.091,95%CI:1.002-1.188,P=0.046)was negatively correlated with favorable prognosis,and postcirculation Alberta stroke program early CT score(pc-ASPECTS)(OR=0.431,95%CI:0.207-0.896,P=0.024)was positively correlated with favorable prognosis,and collateral circulation(OR=0.228,95%CI:0.080-0.647,P=0.005)was positively correlated with favorable prognosis,with statistical significance in the model(P<0.05).Conclusion Low admission NIHSS score,high pc-ASPECTS and good collateral circulation are factors influencing favorable prognosis.