血管内取栓次数与急性缺血性卒中预后的关系

发布时间：2018-05-15 22:07

本文选题：脑缺血 + 卒中　；参考：《中国脑血管病杂志》2017年10期

【摘要】：目的探讨急性缺血性卒中患者血管内治疗中取栓次数与预后的关系。方法回顾性连续收集2014年6月至2016年6月在南京军区南京总医院行急诊血管内取栓的61例缺血性卒中患者的临床资料。根据取栓次数将患者分为常规取栓组(3次,48例)和多次取栓组(≥3次,13例)。采用改良Rankin量表(mRS)评估两组患者90 d的神经功能预后。将mRS评分0~2分定义为预后良好,3~6分定义为预后不良,其中6分代表死亡。采用单因素分析比较组间差异(剔除DSA资料缺失或质量差者),采用Spearman相关分析评价取栓次数与预后及病死率的关系。结果单因素分析显示,常规取栓组血管再通发生率[73.9%(34/46)比25.0%(3/12),P=0.005]和良好侧支代偿发生率[55.6%(25/45)比8.3%(1/12),P=0.004]高于多次取栓组,常规取栓组症状性颅内出血发生率低于多次取栓组[14.6%(7/48)比53.8%(7/13),P=0.003]。61例患者90 d病死率为18.0%(11例)。进一步行Spearman相关分析显示,取栓次数与死亡呈中度正相关(r=0.517,P=0.000),取栓次数与良好功能预后无明显相关性(r=0.076,P=0.560),但尚不能排除血管再通率、侧支代偿和症状性出血差异的影响。结论急诊血管内介入治疗多次取栓与急性缺血性卒中患者90 d病死率呈正相关,但仍需更大样本量的研究以进一步验证两者间的关系。
[Abstract]:Objective to investigate the relationship between the times of thrombus removal and prognosis in patients with acute ischemic stroke. Methods the clinical data of 61 patients with ischemic stroke who underwent emergency endovascular thrombectomy from June 2014 to June 2016 in Nanjing General Hospital of Nanjing military region were collected retrospectively. According to the number of thrombus removal, the patients were divided into two groups: the routine thrombectomy group (n = 48) and the multiple thrombectomy group (n = 13). A modified Rankin scale was used to evaluate the prognosis of neurological function in the two groups at 90 d. The mRS score of 0 ~ 2 was defined as good prognosis 3 ~ 6 as poor prognosis, 6 of which represented death. Univariate analysis was used to compare the differences between groups (excluding those with missing or poor DSA data) and Spearman correlation analysis was used to evaluate the relationship between the number of thrombus removal and prognosis and mortality. Results univariate analysis showed that the incidence of recanalization [73.9% 46] and good collateral compensations [55.66% 25 / 45] in routine thrombectomy group was higher than that in repeated thrombectomy group [73.9% / 46] and good collateral compensatory rate [55.66% 25 / 45] vs 8.3% / 12% P0. 004] higher than that in multiple thrombectomy group. The incidence of symptomatic intracranial hemorrhage in the routine thrombectomy group was lower than that in the multiple thrombectomy group [14.610 / 48] and 53.8R / 13P 0.003] .61 patients had a 90-day mortality of 18.0%. Further Spearman correlation analysis showed that there was a moderate positive correlation between the number of thrombus removal and death. There was no significant correlation between the number of thrombectomy and good functional prognosis. However, the effects of vascular recanalization rate, collateral compensation and symptomatic hemorrhage could not be ruled out. Conclusion there is a positive correlation between multiple thrombectomy and 90 days mortality in patients with acute ischemic stroke, but more sample size is needed to further verify the relationship between the two.
【作者单位】：南京大学医学院金陵医院南京军区南京总医院神经内科;
【分类号】：R743.3

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