摘要
目的探讨高龄急性缺血性卒中(AIS)患者急性期血管再通治疗的疗效。方法回顾性分析2010年1月至2018年7月在北京医院行血管再通治疗的141例AIS患者的临床资料,患者年龄31~96岁,其中34例≥80岁(高龄组)、107例<80岁(低龄组)。分析高龄AIS患者采用不同血管再通治疗的疗效。结果高龄AIS患者更易合并心房颤动[高龄组61.8%(21/34),低龄组33.6%(36/107),χ^2=8.47,P<0.01]和冠心病[高龄组58.8%(20/34),低龄组32.7%(35/107),χ^2=7.40,P<0.01],其他危险因素比较差异无统计学意义(P>0.05)。高龄组美国国立卫生研究院卒中量表评分(NIHSS)为[16(13,21)分],高于低龄组[11(6,16)分],差异有统计学意义(Z=3.74,P<0.01)。在病因分型中,高龄组以心源性栓塞型为主(58.8%,20/34),低龄组以大动脉粥样硬化型为主(46.7%,50/107),两组比较差异有统计学意义(χ^2=12.11,P<0.01)。在血管再通方法中,高龄组和低龄组静脉溶栓比例为35.3%(12/34)和48.6%(52/107),血管内治疗比例为52.9%(18/34)和36.4%(39/107),静脉溶栓桥接血管内治疗比例为11.8%(4/34)和15.0%(16/107),两组比较差异无统计学意义(χ^2=2.93,P=0.23)。从发病到治疗的时间高龄组为195(154,269)min,低龄组为215(153,280)min,两组比较差异无统计学意义(Z=1.03,P=0.30)。高龄组90 d功能独立率(改良Rankin评分≤2分)较低龄组低[35.3%(12/34)比56.1%(60/107),χ^2=4.46,P<0.05],高龄组治疗后90 d内病死率高于低龄组[29.4%(10/34)比8.4%(9/107),χ^2=9.76,P<0.01],高龄组症状性颅内出血率较低龄组高[11.8%(4/34)比7.5%(8/107)],但差异无统计学意义(P>0.05)。结论高龄AIS患者急性期血管再通治疗效果差于低龄患者,治疗90 d内病死率更高,功能独立率更低。
Objective To analyze the efficacy of revascularization in oldest-old patients with acute ischemic stroke(AIS).Methods The clinical data of AIS patients receiving recanalization therapy in Beijing Hospital from January 2010 to July 2018 were retrospectively reviewed.Among 141 patients,there were 34 cases aged≥80 years(oldest-old group)and 107 cases aged<80 years(old group).The clinical characteristics and outcomes of two groups were analyzed and compared.Results The proportions of patients with atrial fibrillation and coronary heart disease in oldest-old group were high than those in the old group[61.8%(21/34)vs.33.6%(36/107),χ^2=8.47,P<0.01;58.8%(20/34)vs.32.7%(35/107),P<0.01,respectively];while there were no significant differences in other risk factors between two groups(P>0.05).The National Institute of Health Stroke Scale Score(NIHSS)was higher in the oldest-old group than that in old group[16(13,21)vs.11(6,16),Z=3.74,P<0.01].In the etiological classification,cardiogenic embolism was the main cause in the oldest-old group(58.8%,20/34),while large artery atherosclerosis was the main cause in the old group(46.7%,50/107,χ^2=12.11,P<0.01).There were no significant differences between the two groups in the methods of recanalization[intravenous thrombolysis were 35.3%(12/34)and 48.6%(52/107);endovascular therapy were 52.9%(18/34)and 36.4%(39/107),bridging therapy were 11.8%(4/34)and 15.0%(16/107),respectively;χ^2=2.93,P=0.23]and the time from onset to treatment[195(154,269)min vs.215(153,280)min,Z=1.03,P>0.05].The 3-month independent(modified Rankin score≤2)rate was lower in the oldest-old group than that in the old group[35.3%(12/34)vs.56.1%(60/107),χ^2=4.46,P<0.05).The 3-month mortality was higher in the oldest-old group than that in the old group[29.4%(10/34)vs.8.4%(9/107),χ^2=9.76,P<0.01].There was a tendency of increased incidence of symptomatic intracranial hemorrhage(SICH)in the oldest-old patients compared to the old patients[11.8%(4/34)vs.7.5%(8/107),P>0.05].Conclusion The conditions of AIS patien
作者
陈玉辉
徐蕾
陆军
祁鹏
陈涓
龚涛
Chen Yuhui;Xu Lei;Lu Jun;Qi Peng;Chen Juan;Gong Tao(Department of Neurology,Beijing Hospital,National Center of Gerontology,Beijing100730,China;Department of Neurosurgery,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)
出处
《中华全科医师杂志》
2020年第1期37-43,共7页
Chinese Journal of General Practitioners
基金
北京医院临床研究121工程项目(121-2016006)。
