摘要
目的观察机械取栓治疗大血管闭塞急性缺血性脑卒中后患者的脑水肿严重程度,并分析影响患者预后的相关因素。方法将2021年10月至2022年10月在该院进行机械取栓治疗的91例前循环大血管闭塞急性缺血性脑卒中患者作为研究对象,根据患者脑水肿严重程度分为Ⅰ组(轻度)、Ⅱ组(中度)、Ⅲ组(重度);治疗后12周利用改良Rankin量表进行预后评估,分为预后优良组和预后不良组,采用单因素分析、多因素logistic回归模型分析脑水肿程度与预后的影响因素。结果单因素分析显示Ⅰ组、Ⅱ组、Ⅲ组入院时美国国立卫生研究院卒中量表(NIHSS)评分≥15分、发病至溶栓时间≥6 h、高血压、血管成功再通、侧支循环优良患者百分比差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,入院时NIHSS评分≥15分、发病至溶栓时间≥6 h、高血压病史是导致脑水肿严重的危险因素,而血管成功再通是脑水肿的保护因素(P<0.05)。单因素分析提示预后优良组侧支循环优良、血管成功再通、重度脑水肿、高血压、发病至溶栓时间≥6 h、入院时NIHSS评分≥15分患者百分比与预后不良组比较,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,重度脑水肿、发病至溶栓时间≥6 h、入院时NIHSS评分≥15分是预后不良的危险因素,而侧支循环优良、血管成功再通是预后良好的积极因素(P<0.05)。结论有高血压且发病至溶栓时间≥6 h、入院时NIHSS评分≥15分的机械取栓患者,治疗后脑水肿程度越严重;而重度脑水肿、发病至溶栓时间≥6 h、入院时NIHSS评分≥15分是影响机械取栓患者预后的不良因素。
Objective To observe the severity of cerebral edema after mechanical thrombectomy in the patients with acute ischemic stroke caused by large vessel occlusion,and to statistically analyze the related factors affecting the prognosis quality of the patients,so as to guide the patients to conduct scientific intervention.Methods Ninety-one patients with acute ischemic stroke due to anterior circulation large vessel occlusion treated with mechanical thrombectomy in this hospital from October 2021 to October 2022 served as the analytic subjects.According to the severity of brain edema,they were divided into the groupⅠ(mild),groupⅡ(moderate),and groupⅢ(severe);after 12-week treatment,the improved Rankin scale was used to evaluate the prognosis.The patients with good prognosis were included in the excellent group,and the patients with poor prognosis were included in the poor group.Single factor and multifactor logistic analysis was used to analyze the influencing factors and prognostic related factors of different degrees of brain edema.Results The univariate analysis showed that the percentage of patients with NIHSS score at admission≥15,time from onset to thrombolysis≥6 h,history of hypertension,successful vascular recanalization and good collateral circulation were significantly different among the groupsⅠ,ⅡandⅢ(P<0.05);the multivariate logistic regression analysis results showed that the NIHSS score at admission≥15,time from onset to thrombolysis≥6 h,and hypertension history were the risk factors leading to severe cerebral edema,while successful recanalization of blood vessels was a protective factor for cerebral edema(P<0.05).The univariate analysis showed that in the good prognosis group the percentage of patients had good circulation of lateral branches,successful recanalization of blood vessels,severe cerebral edema,hypertension,time from onset to thrombolysis≥6 h,and NIHSS score≥15 at admission were significantly different from those in the poor prognosis group(P<0.05).The multivariate log
作者
幸文利
谭关平
段佳
XING Wenli;TAN Guanping;DUAN Jia(Department of Cerebrovascular Diseases,Suining Municipal Central Hospital,Suining,Sichuan 629000,China)
出处
《重庆医学》
CAS
2024年第4期582-586,共5页
Chongqing medicine
关键词
大血管闭塞
急性缺血性脑卒中
机械取栓
脑水肿
预后因素
great vascular occlusion
acute ischemic stroke
mechanical thrombectomy
brain edema
prognostic factors
