急诊血管内介入治疗后颅内发生高密度影的有关因素及预后分析

Analysis of relevant factors and prognosis of intracranial highdensity shadow after emergency endovascular intervention treatment

目的探讨急诊血管内介入治疗术后患者颅内高密度影的发生率及其影响因素,及高密度影与临床预后的相关性。方法选取2020年6月至2021年6月宜宾市第一人民医院收治的100例接受血管内介入治疗的脑卒中患者作为研究对象。术后即刻进行头颅CT平扫复查,根据患者是否存在高密度影,并将其分为高密度影组(52例)及非高密度影组(48例)。比较两组患者的术前美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、头颅CT阿尔伯塔脑卒中计划早期诊断评分(ASPECTS)、术中美国介入和治疗神经放射学会/介入放射学学会(ASTIN/SIR)分级、术后改良脑梗死溶栓血流分级(mTICI)、术后良好预后(mRS≤3分)率等指标。结果纳入研究的100例患者术后3、6、12个月的良好预后率分别为34.00%、52.00%、54.00%。两组患者术中ASTIN/SIR分级、术后mTICI再通等级及3个月的良好预后率比较,差异均有统计学意义(P<0.05),而在其他术后指标上差异无统计学意义(P>0.05)。结论对于侧支循环良好的患者,术中操作需更加警惕,术后需加强病情关注,并注意影像学复查评估,减少造影剂外渗对患者预后产生影响。

Objective To investigate the incidence and impacting factors of intracranial high-density shadow after emergency endovascular intervention treatment,and the correlation between high-density shadow and clinical prognosis.Methods A total of 100 stroke patients undergoing endovascular intervention treatment admitted to the First People’s Hospital of Yibin from June 2020 to June 2021 were selected as the research object.Immediately after operation,the plain CT scan of the skull was reexamined to determine whether there was high-density shadows.The patients were divided into the high-density shadow group(n=52)and the non-high density shadow group(n=48).The preoperative National Institute of Health Stroke Scale(NIHSS),the modified Rankin scale(mRS),the alberta stroke program early CT score(ASPECTS),intraoperative American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Vessel Grading System(ASTIN/SIR)classification,the modified thrombolysis in cerebral infarction(mTICI)after operation,and the good prognosis(mRS score≤3)rate after operation,etc.,were compared between the two groups of patients.Results The good prognosis rates at 3,6,and 12 months postoperatively for the 100 patients included in the study were 34.00%,52.00%,and 54.00%,respectively.It was discovered that there were all statistically significant differences in intraoperative ASTIN/SIR grade,postoperative mTICI recanalization grade and good prognosis rate for 3 months(P<0.05),while there were no statistically significant differences in other postoperative indices(P>0.05).Conclusion For patients with good collateral circulation,more caution should be exercised during operation,and postoperative attention should be paid to the condition.Imaging review and evaluation should be emphasized to reduce the impact of contrast agent extravasation on the prognosis of patients.