急性后循环脑梗死患者早期神经功能恶化的危险因素分析

Risk factors of early neurological deterioration in patients with acute posterior circulation infarction

目的 观察急性后循环脑梗死(APCI)患者早期神经功能恶化(END)发生情况,探讨其发生的危险因素及预后。方法 2021年1月—2022年12月河南省人民医院诊治APCI患者316例,根据是否出现END分为END组75例和非END组241例。比较2组入院时美国国立卫生研究院卒中量表评分(NIHSS)、病因分型、梗死部位等临床资料;采用后循环Alberta脑卒中早期CT诊断评分(pc-ASPECTS)评估梗死范围;采用多因素logistic回归分析APCI患者发生END的影响因素。发病14 d、1个月、3个月采用改良Rankin量表评分(mRS)评估2组患者神经功能状态,比较预后良好(mRS 0~2分)率。结果 (1)316例APCI患者发生END 75例(23.73%)。END组入院NIHSS[3.0(2.0,5.0)分]、pc-ASPECTS[3.0(2.0,7.0)分]及大动脉粥样硬化、颞枕叶梗死、脑桥梗死比率(73.3%、12.0%、66.7%)均高于非END组[2.0(1.0,3.0)分、2.0(1.5,8.0)分、40.7%、9.1%、47.7%(P<0.05)]。(2)大动脉粥样硬化(OR=1.375,95%CI:1.180~1.779,P=0.009)、颞枕叶梗死(OR=2.860,95%CI:1.011~8.092,P=0.048)、脑桥梗死(OR=2.860,95%CI:1.324~16.351,P=0.048)、入院NIHSS(OR=1.245,95%CI:1.031~1.503,P=0.020)是APCI患者发生END的影响因素。(3)END组患者发病14 d、1个月、3个月预后良好率(45.3%、57.3%、65.3%)均低于非END组(79.7%、84.6%、91.3%)(P<0.05)。结论 有大动脉粥样硬化、颞枕叶梗死、脑桥梗死及入院NIHSS高的APCI患者发生END的风险较大,APCI患者发生END后预后较差。

Objective To observe the occurrence of early neurological deterioration(END) in patients with acute posterior circulation infarction(APCI),and to investigate the risk factors and prognosis.Methods A total of 316patients with APCI in Henan Provincial People's Hospital from January 2021 to December 2022 were divided into END group(n=75) and non-END group(n=241) according to the presence of END,and were compared the clinical data on admission such as NIHSS score,etiology classification and infarction site.The infarction area was assessed by posterior circulation Alberta stroke program early CT score(pc-ASPECTS) and the influencing factors of END were analyzed by multivariate logistic regression.The neurological status was assessed by modified Rankin scale(mRS) scores 14 d,1 month,and 3 months after onset.The proportion of good prognosis(mRS:0-2) was compared between two groups.Results(1) Among 316 patients with APCI,75 patients developed END(23.73%).The admission NIHSS score,admission pc-ASPECTS,and percentages of patients with large artery atherosclerosis,temporo-occipital infarction and cerebral pontic infarction were higher in END group [3.0(2.0,5.0),3.0(2.0,7.0),73.3%,12.0%,66.7%]than those in non-END group [2.0(1.0,3.0),2.0(1.5,8.0),40.7%,9.1 %,47.7%](P<0.05).(2) Large artery atherosclerosis(OR=1.375,95 % CI:1.180-1.779,P=0.009),temporo-occipital infarction(OR=2.860,95 % CI:1.011-8.092,P=0.048),pontic infarction(OR=2.860,95%CI:1.324-16.351,P=0.034),and admission NIHSS score(OR=1.245,95%CI:1.031-1.503,P=0.020) were the influencing factors of END in APCI patients.(3) The proportions of good prognosis were lower in END group 14 d,1 month and 3 months after onset(45.3%,57.3%,65.3%) than those in non-END group(79.7%,84.6%,91.3%)(P<0.05).Conclusion APCI patients with large artery atherosclerosis,temporo-occiptal infarction,pontic infarction,and high admission NIHSS score are at a high risk of END,and APCI patients have poor prognosis after END.