老年颅内大动脉急性闭塞患者经治疗再通后颅内出血的影响因素

The influencing factors of intracranial hemorrhage in elderly patients with acute occlusion of intracranial arteries after treatment and reperfusion

目的探讨老年颅内大动脉急性闭塞患者经治疗再通后颅内出血的影响因素。方法回顾性选取2019年2月至2021年5月在河北中石油中心医院治疗的老年颅内大动脉急性闭塞患者,采用机械取栓治疗的60例患者为观察组,采用动静脉联合溶栓治疗的60例患者为对照组,观察比较两组血管再通率、颅内出血发生率等,同时采用多因素logistic回归分析颅内出血发生的影响因素。结果观察组血管再通率为85.00%(51/60),明显高于对照组的68.33%(41/60),差异有统计学意义(χ^(2)=4.658,P=0.031)。观察组治疗后美国国立卫生院神经功能缺损评分(NIHSS)为(10.57±2.23)分,明显低于对照组[(14.73±2.84)分],差异有统计学意义(P<0.05)。观察组年龄<80岁患者血管再通率明显高于年龄≥80岁患者(P<0.05)。单因素分析结果显示:颅内出血和无颅内出血患者年龄、入院时NIHSS评分和Alberta卒中计划早期CT评分(ASPECTS)、中性粒细胞绝对值/淋巴细胞比例(NLR)比较差异有统计学意义(均P<0.05);多因素logistic回归分析显示年龄(OR=1.756,95%CI:1.184~2.604)、入院时NIHSS评分(OR=2.392,95%CI:1.401~4.084)是老年颅内大动脉急性闭塞术后并发颅内出血的危险因素,而ASPECTS(OR=0.364,95%CI:0.190~0.697)是保护因素。结论机械取栓治疗老年颅内大动脉急性闭塞患者有较好的临床效果,值得临床使用;再通后颅内出血主要受患者年龄、入院时NIHSS、ASPECTS的影响。

Objective To explore the influencing factors of intracranial hemorrhage in elderly patients with acute occlusion of intracranial arteries after treatment and reperfusion.Methods A retrospective selection was conducted on elderly patients with acute occlusion of the intracranial artery who were treated at the Hebei Petro China Central Hospital from February 2019 to May 2021.Sixty patients who received mechanical thrombectomy treatment were selected as the observation group,and 60 patients who received combined arterial and venous thrombolysis treatment were selected as the control group.The vascular reperfusion rate and incidence of intracranial hemorrhage were observed and compared between the two groups.Meanwhile,multiple logistic regression analysis was used to identify the influencing factors of intracranial hemorrhage.Results The reperfusion rate of the observation group's blood vessels was 85.00%(51/60),significantly higher than the control group's 68.33%(41/60),and the difference was statistically significant(χ^(2)=4.658,P=0.031).The National Institutes of Health Neurological Deficit Score(NIHSS)of the observation group after treatment was(10.57±2.23),significantly lower than that of the control group(14.73±2.84),and the difference was statistically significant(P<0.05).The reperfusion rate of blood vessels in patients under 80 years old in the observation group was significantly higher than that in patients≥80 years old(P<0.05).The results of univariate analysis showed that there were statistically significant differences in age,NIHSS at admission,Alberta Stroke Program Early CT Score(ASPECTS),and neutrophil absolute value/lymphocyte ratio(NLR)between patients with and without intracranial hemorrhage(all P<0.05);Multivariate logistic regression analysis showed that age(OR=1.756,95%CI:1.184-2.604)and NIHSS at admission(OR=2.392,95%CI:1.401-4.084)were risk factors for postoperative intracranial hemorrhage in elderly patients with acute occlusion of the large intracranial artery,while ASPECTS(OR=0.364,95%CI:0.190-0.697)was a protective factor.Conclusions Mechanical thrombectomy has good clinical efficacy in the treatment of elderly patients with acute occlusion of intracranial arteries,and is worthy of clinical use;The intracranial hemorrhage after reperfusion is mainly influenced by the patient's age,NIHSS at admission,and ASPECTS.