左室收缩功能障碍与6 h内机械取栓的前循环大血管闭塞性AIS患者早期神经功能结局的关系分析

Analysis of the correlation of left ventricular systolic dysfunction with early neurological outcomes in anterior circulation large vessel occlusive AIS patients with mechanical thrombectomy within 6 h after onset

目的探讨以左室射血分数(LVEF)测量的左室收缩功能障碍(LVSD)与6 h内接受机械取栓治疗的前循环大血管闭塞性急性缺血性脑卒中(AIS)患者早期神经功能结局的关系。方法回顾性分析205例发病后6 h内接受机械取栓治疗的前循环大血管闭塞性AIS患者的临床资料,采用Simpson双平面法在二维超声心动图上评估患者的LVEF,观察LVSD的发生情况,并比较LVSD组和非LVSD组患者的临床资料,采用多因素Logistic回归模型分析LVSD与早期神经功能结局的关系。结果205例患者中47例(22.9%)出现LVSD。LVSD组患者年龄(72.8±11.6)岁、基线美国国立卫生研究院卒中量表(NIHSS)评分16.0(10.0,20.0)分高于非LVSD组的(67.2±10.2)岁、11.0(6.0,16.0)分,LVEF(37.9±7.5)%、早期神经功能改善率36.2%低于非LVSD组的(62.8±3.4)%、71.5%,差异具有统计学意义(P<0.05)。205例患者中,早期神经功能改善130例(63.4%),未改善75例(36.6%)。单因素分析显示:早期神经功能改善组患者年龄、基线NIHSS评分、LVSD、再灌注不良[改良脑梗死溶栓评分(mTICI)0~2a级]发生率分别为(67.3±10.0)岁、11.0(6.0,16.0)分、13.1%、10.8%,均低于早期神经功能未改善组的(70.5±11.8)岁、13.0(8.0,18.0)分、40.0%、37.3%,差异具有统计学意义(P<0.05)。多因素Logistic回归模型分析显示:LVSD和再灌注不良是6 h内接受机械取栓治疗的前循环大血管闭塞性AIS患者早期神经功能结局的独立危险因素(P<0.05)。结论LVSD是发病后6 h内接受机械取栓治疗的前循环大血管闭塞性AIS患者早期神经功能结局的独立危险因素。

Objective To investigate the correlation of left ventricular systolic dysfunction(LVSD)as measured by left ventricular ejection fraction(LVEF)with early neurological outcomes in anterior circulation large vessel occlusive acute ischemic stroke(AIS)patients who received mechanical thrombectomy within 6 h after onset.Methods Clinical data of 205 patients with anterior circulation large vessel occlusive AIS who received mechanical thrombolectomy within 6 h after onset were retrospectively analyzed.Simpson biplane method was used to evaluate the LVEF of patients on two-dimensional echocardiography,and the occurrence of LVSD was observed.The clinical data of LVSD group and non-LVSD group were compared,and multivariate Logistic regression model was used to analyze the correlation between LVSD and early neurological outcome.Results 47(22.9%)of 205 patients developed LVSD.In LVSD group,the age was(72.8±11.6)years was and the baseline National Institutes of Health Stroke Scale score was 16.0(10.0,20.0)points,which were higher than those of(67.2±10.2)years and 11.0(6.0,16.0)points in non-LVSD group;LVEF of(37.9±7.5)%and early neurological improvement rate of 36.2%in LVSD group were lower than those of(62.8±3.4)%and 71.5%in non-LVSD group;the difference were statistically significant(P<0.05).Of the 205 patients,early neurological function improved in 130 cases(63.4%)and did not improve in 75 cases(36.6%).Single factor analysis showed that:age,baseline NIHSS score and incidence of LVSD and poor reperfusion[modified treatment in cerebral ischemia(mTICI)grade 0-2a]in group with improvement in early neurological function were(67.3±10.0)years,11.0(6.0,16.0)points,13.1%and 10.8%,which were lower than those of(70.5±11.8)years,13.0(8.0,18.0)points,40.0%,37.3%in group with no improvement in early neurological function,and the differences were statistically significant(P<0.05).Multivariate Logistic regression model analysis showed that LVSD and poor reperfusion were independent risk factors for early neurological outcomes in anterior circulation large vessel occlusive AIS patients who received mechanical thrombolectomy within 6 h after onset(P<0.05).Conclusion LVSD is an independent risk factor for early neurological outcomes in patients with anterior circulation large vessel occlusive AIS who receive mechanical thrombolectomy within 6 h after onset.