症状性动脉粥样硬化性颈内动脉或大脑中动脉闭塞颅内外血运重建术后并发症的预警因素及短期疗效分析

Analysis of predictive factors and short-term efficacy of complications after intracranial-extracranial revascularization for symptomatic atherosclerotic internal carotid artery or middle cerebral artery occlusion

目的探讨症状性动脉粥样硬化性颈内动脉(ICA)或大脑中动脉(MCA)闭塞患者颅内外血运重建术后并发症的预警因素及短期疗效。方法回顾性分析2019年1月至2023年3月于首都医科大学附属北京天坛医院神经外科学中心行颅内外血运重建术的ICA或MCA闭塞患者的临床资料,共纳入120例(120侧手术)。根据术后14 d内是否发生并发症将患者分为并发症组和无并发症组,比较两组临床资料的差异,将差异有统计学意义的指标纳入多因素logistic回归模型中筛选影响术后并发症的预警因素。应用1∶2倾向评分匹配方法筛选并发症组与无并发症组患者,比较两组术后3~6个月的改良Rankin量表评分(mRS)和CT灌注加权成像(CTP)分期的差异。结果120例患者术后共19例(15.83%)发生并发症,其中脑梗死5例(4.17%),脑出血2例(1.67%),暂时性神经功能障碍12例(10.00%)。与无并发症组比较,并发症组患者手术侧别为左侧的占比高,术前收缩压及红细胞比容高,术后第1天白细胞计数、中性粒细胞与淋巴细胞比值(NLR)、全身免疫炎症指数均高,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,术前收缩压高(OR=1.06,95%CI:1.01~1.11,P=0.022),术后第1天NLR高(OR=1.14,95%CI:1.04~1.24,P=0.006),手术侧为左侧(OR=12.87,95%CI:2.68~61.70,P=0.001)是患者术后发生并发症的预警因素。应用1∶2倾向评分匹配的并发症组(15例)与无并发症组(25例)患者比较,术后3~6个月mRS及CTP分期的差异均无统计学意义(均P>0.05)。结论术前收缩压高、术后第1天NLR高、手术侧为左侧是症状性动脉粥样硬化性ICA或MCA闭塞患者颅内外血运重建术后并发症的预警因素;术后新发生并发症对患者短期疗效无明显影响。

Objective To investigate the early warning factors and short-term efficacy of complications after intracranial-extracranial revascularization in patients with symptomatic atherosclerotic internal carotid artery(ICA)or middle cerebral artery(MCA)occlusion.Methods The clinical data of patients with symptomatic atherosclerotic ICA or MCA occlusion who underwent intracranial-extracranial revascularization at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from January 2019 to March 2023 were retrospectively analyzed.A total of 120 cases(120 sides,all first surgery)were included.According to whether complications occurred within 14 days after surgery,the patients were divided into a complication group and a non-complication group.The differences in clinical data between the two groups were analyzed,and the indicators with statistically significant differences were included in the multivariate logistic regression model to screen the related factors affecting postoperative complications.The 1∶2 propensity score matching method was used to screen the complication group and the non-complication group.We then compared the differences in modified Rankin Scale score(mRS)and CT perfusion-weighted imaging(CTP)staging between the two groups 3 to 6 months after surgery.Results A total of 19 cases(15.83%)of 120 patients had postoperative complications,including 5 cases(4.17%)of cerebral infarction,2 cases(1.67%)of cerebral hemorrhage,and 12 cases(10.00%)of transient neurological dysfunction.Compared with the non-complication group,patients in the complication group had a higher proportion of surgery on the left side,higher preoperative systolic blood pressure and hematocrit,higher white blood cell count and neutrophil-to-lymphocyte ratio(NLR)on the first postoperative day,higher systemic immune inflammation index,and the differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that high preoperative systolic blood pressure(OR=1.06,95%CI:1.01-1.11,P=0.022)and high NLR on the first day after surgery(OR=1.14,95%CI:1.04-1.24,P=0.006),and the surgical side being the left side(OR=12.87,95%CI:2.68-61.70,P=0.001)were early warning factors for postoperative complications in patients.Comparing the complication group(15 cases)and the non-complication group(25 cases)using 1∶2 propensity score matching,there was no statistically significant difference in mRS or CTP staging 3 to 6 months after surgery(both P>0.05).Conclusions High preoperative systolic blood pressure,high NLR on the first postoperative day,and left-sided surgery are early warning factors for complications after intracranial-extracranial revascularization in patients with symptomatic atherosclerotic ICA or MCA occlusion.Newly-developed postoperative complications have no significant impact on the patient′s short-term outcomes.