姜大宇,
陈晓旭,
汪新宇,
李国栋,
任家洋
大连医科大学附属友谊医院 神经外科, 辽宁 大连 116001

详细信息 作者简介: 姜大宇(1975-), 男, 副主任医师。E-mail:jdyb@163.com





中图分类号: R459.7


摘要:目的探究急诊机械取栓治疗急性后循环缺血性脑卒中患者的临床效果及预后影响因素。方法选取2017年1月至2019年7月因后循环缺血性脑卒中行急诊机械取栓治疗的80例患者为研究对象，使用改良脑梗死溶栓分级（mTICI）评价术后血管再通情况，于入院时及出院前1天采用美国国立卫生研究院卒中量表（NIHSS）进行评分。所有患者随访100天，根据改良Rankin量表评分（mRS）将患者分为预后良好组（0≤mRS≤2）和预后不良组（3≤mRS≤6），分析两组患者基线与临床资料。结果术后血管再通率为73.75%（59/80），其中mTICI 3级为58.75%（47/80），mTICI 2a级为26.25%（21/80），mTICI 2b级为15.00%（12/80），血管未能再通患者占12.50%（10/80）。治疗后较治疗前NIHSS评分显著降低，差异具有统计学意义（P < 0.05）。预后良好组53例，预后不良组27例。两组患者在性别及年龄、入院Alberta卒中早期卒中CT评分（ASPECTS）、入院NIHSS评分、侧支代偿良好比例、并发糖尿病、高血压等基线资料相比差异具有统计学意义（P < 0.05）。两组患者血管再通率、术后症状性颅内出血、发病至血管再通时间、发病至穿刺时间等临床资料比较差异具有统计学意义（P < 0.05），两组手术时间比较差异无统计学意义（P>0.05）。Logistic多因素分析结果显示：年龄增高、入院高NIHSS评分、合并高血压、发病至再通时间延长、术后发生症状性颅内出血为预后危险因素（P < 0.05）。入院高ASPECTS评分、高侧支代偿比例及成功再通为预后保护因素（P < 0.05）。结论急诊机械取栓治疗对后循环缺血性脑卒中患者具有较好的治疗效果，入院高NIHSS评分、发病至血管再通时间延长、术后发生症状性颅内出血等为预后危险因素，入院高ASPECTS评分、高侧支代偿比例及成功再通为预后保护因素。
关键词: 脑血管循环/
脑梗死/
机械取栓/
疗效/
预后


Abstract:ObjectiveTo investigate the clinical effect and prognostic factors of emergency mechanical thrombectomy in the treatment of acute posterior circulation ischemic stroke.MethodsEighty patients with posterior circulation ischemic stroke, who underwent emergency mechanical thrombectomy in our hospital from January 2017 to July 2019, were enrolled in the study. Postoperative vascular recanalization was evaluated by modified cerebral infarction thrombolytic grade (mTICI), and National Institutes of Health Stroke scale (NIHSS) was used to score at admission and the day before discharge. All patients were followed up for 100 days. According to the modified Rankin scale score (mRS), the patients were divided into two groups:good prognosis group (0 ≤ mRS ≤ 2) and poor prognosis group (3 ≤ mRS ≤ 6). The baseline and clinical data between the two groups were analyzed.ResultsThe postoperative vascular recanalization rate was 73.75% (59/80), of which mTICI grade 3 was 58.75% (47/80), mTICI grade 2a 26.25% (21/80), mTICI grade2b 15.00% (12/80). The patients with failed vascular recanalization accounted for 12.50% (10/80). The NIHSS score after treatment was significantly higher than that before treatment (P < 0.05). Among them, 53 patients had good prognosis and 27 had poor prognosis. All patients were followed up for 100 days, the rate of good prognosis was 66.25% and the rate of poor prognosis 33.75%. There were significant differences between the two groups in gender, age, early stroke CT score (ASPECTS), admission NIHSS score, proportion of good collateral compensation, complicated diabetes, hypertension and other baseline data (P < 0.05). There were significant differences in clinical data such as vascular recanalization rate, postoperative symptomatic intracranial hemorrhage, time from onset to recanalization and time from onset to puncture between the two groups (P < 0.05). There was no significant difference in operation time between the two groups (P>0.05). Logistic multivariate analysis revealed that increased age, high NIHSS score on admission, hypertension, prolonged time from onset to recanalization and postoperative symptomatic intracranial hemorrhage were risk factors for prognosis (P < 0.05), while high ASPECTS score on admission, high compensatory ratio of lateral branches and successful recanalization were protective factors for prognosis (P>0.05).ConclusionsEmergency mechanical thrombectomy can quickly and effectively achieve vascular recanalization, and has a better therapeutic effect on patients with posterior circulation ischemic stroke. High NIHSS score on admission, complicated hypertension, prolonged time from onset to recanalization and symptomatic intracranial hemorrhage after operation are prognostic risk factors. High ASPECTS score, high lateral branch compensation ratio and successful recanalization are prognostic protective factors.
Keywords:cerebral vascular circulation/
cerebral infarction/
mechanical thrombectomy/
curative effect/
prognosis

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