急性基底动脉闭塞血管内介入治疗的临床预后和相关因素分析

Clinical analysis of preoperative severity,body temperature and surgical time window on the outcome of patients of intravascular interventional therapy for acute basilar artery occlusion

目的探究影响血管内介入治疗急性基底动脉闭塞患者临床预后的因素,重点讨论时间窗及术前症状对预后的预测价值。方法回顾性分析2018年4月至2021年10月金华市中心医院神经外科行血管内治疗的51例急性基底动脉闭塞(basilar artery occlusion,BAO)患者的临床资料。分析患者术后90 d的临床预后。分为良好预后组(mRS评分≤2分)及不良预后组(mRS评分>2分)。其中发病时间至股动脉穿刺时间为时间窗(≤6 h,6~12 h,>12 h);术前症状用GCS、NIHSS评分来评估,(GCS 9~15分为轻中度,6~8分为重度,3~5分为特重度);NIHSS评分≥20分。采用单因素和多因素Logistics回归分析影响BAO患者血管内介入治疗预后的危险因素,重点探讨时间窗和术前临床症状与患者预后的关系。结果51例患者血管均再通(100%),术后住院治疗时期4例(7.8%)患者死亡,47例患者的随访时间为3个月,19例(37.2%)预后良好,28例(62.7%)预后不良,其中4例死亡。通过logistic回归分析结果术前症状严重程度(GCS评分、NIHSS评分)为BAO血管内治疗患者的独立预后危险因素(P<0.05)。结论急性基底动脉闭塞血管内介入治疗是安全且有效的;时间窗≤6 h良好预后率更高,特别对于患者术前症状GCS(3-5)、NIHSS评分≥20分预后往往不佳。

Objective To explore the factors affecting the prognosis of patients with acute basilar artery occlusion treated with intravascular therapy,and focus on the prediction of time and preoperative symptoms.Methods the clinical data of 51 patients with acute basilar artery occlusion who underwent endovascular treatment in our hospital from April 2018 to October 2021 were collected and analyzed retrospectively.The immediate recanalization rate and 90 day clinical prognosis were analyzed.The patients were divided into good prognosis group(MRS score≤2)and poor prognosis group(MRS score>2).The time window from onset to femoral artery puncture was<6 hours,6-12 hours and>12 hours.The severity of preoperative clinical symptoms was evaluated by GCS score.GCS 9-15 was mild to moderate,6-8 was severe,and 3-5 was extremely severe.NIHSS score≥20 was severe.Univariate and multivariate logistic regression analysis was used to analyze the risk factors affecting the prognosis of BAO patients after intravascular therapy,focusing on the relationship between time and preoperative symptoms and the prognosis of patients after intravascular therapy.Results 51 patients(100%)were successfully recanalized,4 patients(7.8%)died during postoperative hospitalization,47 patients were followed up for 3 months,19 patients(37.2%)had a good prognosis,28 patients(62.7%)had a poor prognosis,of which 4 died.Logistic regression analysis showed that preoperative symptom severity(GCS score and NIHSS score)was an independent prognostic risk factor for patients treated with BAO intravascular therapy(P<0.05).Conclusion Intravascular interventional therapy for acute basilar artery occlusion is effective and safe.The good prognosis rate is higher when the time is≤6 h,especially for patients with preoperative symptoms,GCS(3-5)and NIHSS score≥20,the prognosis is often poor.