单中心急性缺血性脑卒中机械取栓效果评价及预后影响因素分析

Evaluation of the effect of mechanical thrombectomy and analysis of prognostic influencing factors in single-center acute ischemic stroke

目的探讨急性缺血性脑卒中(AIS)机械取栓(MT)的临床效果评价及其预后影响因素。方法回顾性分析2019年11月~2021年10月我院神经介入中心采用血管内MT治疗的42例AIS患者的临床资料,包括性别、年龄等一般资料,记录高血压、糖尿病等基础病史,术前常规进行基线美国国立卫生研究院卒中量表(NIHSS)评分、记录是否桥接、血管闭塞部位、取栓次数、手术时长、术后血管再通、术后症状性出血等情况。随访90d,根据90d改良Rankin量表(m RS)评分将患者分为预后良好组(mRS评分0~2分)和预后不良组(mRS评分3~6分),采用单因素和多因素Logistic回归分析影响患者预后的因素。结果42例AIS患者中19例(45.2%)获90d良好预后,23例(54.81%)预后欠佳(其中死亡3例)。冠心病、高血压、手术时长、取栓次数、闭塞血管再通率在两组间差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,合并冠心病是预后不良的危险因素(OR=0.01,95%CI:0.00~0.15,P<0.05);闭塞血管再通是预后良好的保护因素(OR=29.09,95%CI:1.39~611.02,P<0.05)。结论MT治疗大血管病变所致AIS安全有效,合并冠心病是预后不良的危险因素,闭塞血管再通是预后良好的保护因素。

Objective To discuss the clinical effect evaluation of mechanical thrombectomy(MT)in acute ischemic stroke(AIS)and its prognostic influencing factors.Methods A retrospective analysis was performed on 42 patients with AIS who were treated with endovascular mechanical thrombectomy in our hospital from Nov 2019 to Oct 2021.General information such as gender and age of patients were collected,basic medical history such as hypertension and diabetes were recorded,and baseline NIHSS score was routinely performed before surgery,whether bridging was recorded,vascular occlusion site,number of thrombectomy,length of surgery,postoperative vascular recanalization,postoperative symptomatic bleeding,etc.After 90 days of follow-up,patients were divided into good prognosis group(mRS score 0~2 points)and poor prognosis group(mRS score 3~6 points)according to the 90 days modified Rankin scale(mRS)score,and univariate and multivariate Logistic regression were used to analyze the factors affecting the prognosis of patients.Results 19 patients(45.2%)had good prognosis of 90 days,and 23 cases(54.81%)had poor prognosis(including 3 cases dead).There were significant differences between the two groups in coronary heart disease,hypertension,length of surgery,number of thrombectomy,and vascular recanalization rate(P<0.05).The results of multivariate Logistic regression analysis showed that coronary heart disease was a risk factor for poor prognosis(OR=0.01,95%CI:0.00~0.15,P<0.05),and occlusive vascular recanalization was a good protective factor for prognosis(OR=29.09,95%CI:1.39~611.02,P<0.05).Conclusion MT treatment for AIS caused by large vessel lesions is safe and effective.Coronary heart disease is a risk factor for poor prognosis.Occlusive vascular recanalization being a protective factor for good prognosis.