文章摘要
龚字翔 ，刘基 ，孙洪扬 ，于萍 ，宁召腾 ，赵璇 ，朱其义 ，王贤军.低NIHSS评分的急性前循环大血管闭塞患者[J].神经损伤功能重建,2024,(4):206-210
低NIHSS评分的急性前循环大血管闭塞患者
Clinical Study on Endovascular Treatment for Acute Anterior Circulation Large Vessel Occlu⁃sion Patients with Low NIHSS Score
  
DOI：
中文关键词: 大血管闭塞  低NIHSS评分  血管内治疗
英文关键词: large vessel occlusion  low NIHSS  Endovascular treatment
基金项目:临沂市重点研发计 划（急性大血管闭 塞性轻型卒中血管 内治疗的疗效及安 全性研究，No. 202 2YX0002）
作者单位
龚字翔1 ，刘基1 ，孙洪扬1 ，于萍2 ，宁召腾1 ，赵璇1 ，朱其义1 ，王贤军1 1. 锦州医科大学研 究生院 2. 临沂市人民医院 神经内科 3. 潍坊医学院研究 生院 4. 山东第一医科大 学（山东省医学科 学院）研究生院 
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中文摘要:
      目的：探讨低美国国立卫生院脑卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分的急 性前循环大血管闭塞患者在不同手术时机行血管内治疗有效性、安全性，评估影响预后的因素。方法：连续 回顾性收集自2020年1月至2021年6月在临沂市人民医院神经内科行急症血管内治疗的89例前循环大血 管闭塞的低NIHSS评分患者（NIHSS评分≤5分）的临床资料。根据患者手术时机的选择分为直接手术组 42例（入院后即行血管内治疗，术后标准药物治疗）和补救手术组47例（入院时先标准药物治疗，患者症状 加重后再行急症血管内补救治疗），比较2组患者临床资料及预后。依据术后90天改良Rankin量表（modified Rankin Scale，mRS）评分将患者分为预后良好组70例（mRS≤2分）和预后不良组19例（mRS＞2分），采 用单因素及多因素Logistic回归分析筛选影响低NIHSS评分大血管闭塞卒中患者血管内治疗预后的因素。 结果：94.4%（84/89）的患者实现了血管成功再通，78.7%（70/89）的患者90天功能预后良好，术后神经系统功 能恶化9例，症状性颅内出血3例，死亡3例。与补救手术组相比，直接手术组患者术后90天预后良好比例 明显较高（90.5% v.s. 68.1%，P＜0.05）。术前低NIHSS评分、直接手术治疗、高侧支循环等级是急性前循环 大血管闭塞性低NIHSS评分患者血管内治疗良好预后的独立影响因素。结论：低NIHSS评分前循环大血管 闭塞患者行血管内治疗可能是安全的，对该类患者尽早行血管内治疗可明显改善预后。
英文摘要:
      To explore the effectiveness and safety of endovascular treatment (EVT) in patients with acute anterior circulation large vessel occlusion (ACLVO) and low National Institutes of Health Stroke Scale (NIHSS) scores at different surgical timings, and to evaluate factors affecting prognosis. Methods: A retrospective collection of clinical data from 89 patients with low NIHSS score (≤5) who underwent emergency EVT for ACLVO at Linyi City People’s Hospital Neurology Department from January 2020 to June 2021. Patients were divided into two groups based on their surgical timing: the direct surgery group (42 cases, who received EVT immediately after admission followed by standard medical therapy) and the rescue surgery group (47 cases, who initially received standard medical therapy upon admission and underwent emergency endovascular rescue treatment if symptoms worsened). The clinical data and outcomes of the two groups were compared. According to the modified Rankin Scale (mRS) score at 90 days post-surgery, patients were divided into a good outcome group (70 cases with mRS ≤2) and a poor outcome group (19 cases with mRS ＞2). Univariate and multivariate logistic regression analyses were used to identify factors affecting the prognosis of endovascular treatment in patients with low NIHSS score ACLVO. Results: Successful recanalization was achieved in 94.4% (84/89) of patients, and 78.7% (70/89) had a good functional outcome at 90 days. There were 9 cases of neurological deterioration post-surgery, 3 cases of symptomatic intracranial hemorrhage, and 3 deaths. Compared to the rescue surgery group, the direct surgery group had a significantly higher proportion of good outcomes at 90 days (90.5% v.s. 68.1%, P<0.05). Preoperative low NIHSS score, direct surgical treatment, and high collateral circulation grade were independent predictors of good outcome in EVT for ACLVO patients with low NIHSS scores. Conclusion: EVT may be safe for patients with ACLVO and low NIHSS scores, and early EVT can significantly improve prognosis in these patients.
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