摘要
目的探讨伴大面积核心梗死的急性缺血性脑卒中(AIS)患者血管内治疗(EVT)的预后及其影响因素。方法回顾性收集临沂市人民医院神经内科自2019年11月至2020年12月收治的139例伴大面积核心梗死(梗死核心区体积≥70 mm^(3))的AIS患者的临床资料,依据是否行EVT分为EVT组(78例)和非EVT组(61例),比较2组患者临床预后的差异;同时依据术后3个月改良Rankin量表(mRS)评分将EVT组患者分为预后良好组(mRS评分≤2分)与预后不良组(mRS评分>2分),采用单因素分析及多因素Logistic回归分析筛选伴大面积核心梗死的AIS患者EVT预后的影响因素。结果与非EVT组相比,EVT组患者的术后3个月预后良好率明显较高(11.48%vs.42.31%),神经功能缺损、脑疝、死亡发生率明显较低,差异均有统计学意义(P<0.05)。与预后不良组相比,预后良好组患者中合并房颤史者比例明显较低,意识清醒者比例明显较高,Alberta卒中项目早期CT(ASPECT)评分明显较高,梗死核心区体积明显较低,侧支循环等级2~4级者比例明显较高,差异均有统计学意义(P<0.05)。ASPECT评分(OR=4.164,95%CI:2.081~8.332,P=0.000)、梗死核心区体积(OR=0.917,95%CI:0.855~0.984,P=0.016)、侧支循环等级(OR=5.113,95%CI:1.104~23.683,P=0.037)是伴大面积核心梗死的AIS患者EVT预后的独立影响因素。结论伴大面积核心梗死的AIS患者行EVT可有效提高预后,降低并发症发生率,其中高ASPECT评分、低梗死核心区体积、高侧支循环等级患者的获益可能性更大。
Objective To explore the clinical prognoses of acute ischemic stroke(AIS)patients with large core infarction after endovascular therapy(EVT)and their influencing factors.Methods Totally,139 AIS patients with large area core infarction(volume of infarction core area≥70 mm^(3))admitted to our hospital from November 2019 to December 2020 were enrolled in our study;their clinical data were analyz ed retrospectively.These patients were divided into EVT group(n=78)and non-EVT group(n=61)according to whether endovascular treatment was performed,and the clinical prognoses of patients from the 2 groups were compared.According to the 3-month modified Rankin scale(mRS)scores,the patients in the EVT group were divided into good prognosis subgroup(mRS scores≤2)and poor prognosis subgroup(mRS scores>2);univariate and multivariate Logistic regressions were used to analyze the independent influencing factors for prognoses of AIS patients with large area core infarction after EVT.Results As compared with those in the non-EVT group,patients in the EVT group had significantly higher good prognosis rate(11.48%vs.42.31%),and significantly lower proportion of patients with neurological deterioration,cerebral hernia and death(P<0.05).As compared with the poor prognosis subgroup,the good prognosis subgroup had significantly lower percentage of patients with atrial fibrillation,significantly higher percentage of conscious patients,significantly higher Alberta stroke program early CT scale(ASPECT)scores,statistically lower volume of infarction core areas,and significantly higher percentage of patients with grading 2-4 in collateral circulation(P<0.05).ASPECT scores(OR=4.164,95%CI:2.081-8.332,P=0.000),volume of infarction core areas(OR=0.917,95%CI:0.855-0.984,P=0.016),and collateral circulation grading(OR=5.113,95%CI:1.104-23.683,P=0.037)were independent influencing factors for prognoses of AIS patients with large area core infarction after EVT.Conclusion EVT can effectively improve the prognoses and reduce the complication rate of AIS
作者
刘基
贺峰
王贤军
王蒙恩
张童童
惠鑫
张利军
陈旺
孙洪扬
Liu Ji;He Feng;Wang Xianjun;Wang Meng'en;Zhang Tongtong;Hui Xin;Zhang Lijun;Chen Wang;Sun Hongyang(Clinical College of Qingdao University,Linyi 276000,China;Graduate School of Weifang Medical College,Weifang 261042,China;Graduate School of Shandong First Medical University(Shandong Academy of Medical Sciences),Taian 271000,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2021年第8期805-811,共7页
Chinese Journal of Neuromedicine
基金
山东省医药卫生科技发展计划项目(2019WS128)。
关键词
大面积核心梗死
急性缺血性脑卒中
血管内治疗
预后
影响因素
Large area core infarction
Acute ischemic stroke
Endovascular therapy
Prognosis
Influencing factor
