急性大血管闭塞性缺血性卒中患者行血管内治疗预后不良的影响因素分析

贺则凡<sup>1</sup>; 孙博<sup>1</sup>; 康慧聪<sup>2</sup>; <sup>1</sup>

文章摘要

贺则凡，孙博，康慧聪,.急性大血管闭塞性缺血性卒中患者行血管内治疗预后不良的影响因素分析[J].神经损伤功能重建,2023,(12):738-743

急性大血管闭塞性缺血性卒中患者行血管内治疗预后不良的影响因素分析

Analysis of Influencing Factors of Poor Prognosis of Patients with Acute Large Vessel Occlu⁃sive Ischemic Stroke Treated by Endovascular Therapy

DOI：

中文关键词: 大血管闭塞缺血性卒中血管内治疗预后

英文关键词: large vessel occlusion ischemic stroke endovascular treatment prognosis

基金项目:国家自然科学基金项目面上项目（No. 81974279）；中国抗癫痫协会优时比基金（No. 202 0020A）；湖北省自然科学基金面上项目（No. 2 022CFB279）；湖北省卫健委面上项目（No. WJ2021 M131）

作者	单位
贺则凡¹ ，孙博¹ ，康慧聪²,¹	1. 山西白求恩医院/山西医学科学院/同济山西医院/ 山西医科大学附属第三医院神经内科 2. 华中科技大学同济医学院附属同济医院神经内科

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中文摘要:

目的：分析血管内治疗（endovascular treatment，EVT）急性大血管闭塞性缺血性卒中患者预后不良的影响因素。方法：纳入2020年6月至2022年12月期间在山西白求恩医院卒中中心接受EVT的急性大血管闭塞性缺血性卒中患者。收集患者临床资料，进行回顾性分析。根据术后90 d改良Rankin量表（modified Rankin Scale，mRS），将患者分为预后良好组（mRS为0～2分）和预后不良组（mRS为3～6分）；根据随访期内患者是否死亡，将患者分为存活组与死亡组；分别比较2组人口统计学资料、手术相关指标和随访结局，采用多因素Logistic回归分析EVT术后患者预后不良的影响因素。结果：本研究共纳入150例患者，其中预后良好组92 例（61.33%），预后不良组58例（38.67%）；存活组129 例（86.00%）和死亡组21例（14.00%）。Logistic 回归分析结果显示入院低 ASPECT 评分（OR=0.575，95%CI 0.391～0.844，P=0.005）、出血转化（OR= 4.349，95%CI 1.032～18.329，P=0.045）为预后不良的危险因素；年龄增加（OR=1.054，95%CI 1.003～1.108， P=0.038）、既往心房颤动（OR=3.856，95%CI 1.111～13.378，P=0.033）、术中直接抽吸（OR=7.562，95%CI 2.314～24.715，P=0.001）及发生出血转化（OR=12.112，95%CI 2.269～64.649，P=0.004）是 EVT 术后患者死亡的危险因素。结论：入院低ASPECT评分、出血转化是急性大血管闭塞性缺血性卒中患者EVT术后预后不良的危险因素；年龄增加、既往心房颤动、术中直接抽吸和发生出血转化是术后死亡的危险因素。

英文摘要:

To analyze the influencing factors of poor prognosis after endovascular treatment (EVT) in patients with acute large vessel occlusive ischemic stroke. Methods: The data of patients with acute large vessel occlusive ischemic stroke treated with EVT in the stroke center of Shanxi Baixuen Hospital from June 2020 to December 2022 were retrospectively analyzed. According to the modified Rankin Scale (mRS) at 90 days after surgery, the patients were divided into good prognosis group (mRS 0-2 points) and poor prognosis group (mRS 3-6 points); according to whether the patient died during the follow-up period, the patients were divided into survival group and death group; respectively, compare the demographic data, surgical related indicators and follow-up outcomes of the two groups, and use multifactorial Logistic regression analysis to analyze the influencing factors of poor prognosis after EVT in patients with acute large vessel occlusive ischemic stroke. Re⁃ sults: A total of 150 patients were enrolled in this study, including 92 cases in the good prognosis group (61.33% ) and 58 cases in the poor prognosis group (38.67% ); 129 cases (86.00% ) survived and 21 cases (14.00% ) died. The results of Logistic regression analysis showed that low admission ASPECT score (OR= 0.575, 95%CI 0.391～0.844, P=0.005) and hemorrhagic transformation (OR=4.349, 95%CI 1.032～18.329, P=0.045) were risk factors for poor prognosis; age increase (OR=1.054, 95% CI 1.003～1.108, P=0.038), previous history of atrial fibrillation (OR=3.856, 95% CI 1.111～13.378, P=0.033), direct aspiration during surgery (OR=7.562, 95%CI 2.314～24.715, P=0.001) and hemorrhagic transformation (OR=12.112, 95%CI 2.269～64.649, P=0.004) were risk factors for death after EVT in patients with acute large vessel occlusive ischemic stroke. Conclusion: Low admission ASPECT score and hemorrhagic transformation are risk factors for poor prognosis after EVT in patients with acute large vessel occlusive ischemic stroke. Age increase, previous history of atrial fibrillation, direct aspiration during surgery and hemorrhagic transformation are risk factors for death after EVT in patients with acute large vessel occlusive ischemic stroke.

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