摘要
目的研究急性中重症脑梗死患者静脉溶栓联合血管内介入治疗预后的影响因素。方法回顾性分析2013年9月至2015年12月在上海长海医院脑血管病中心采用静脉溶栓联合血管内介入治疗的急性中重症脑梗死患者179例的临床资料,均为发病4.5 h内采用静脉溶栓联合至少血管内介入治疗的1种方式（动脉溶栓、机械取栓、支架置入）。根据患者治疗后3个月改良Rankin量表（mRS）评分,将mRS≤2分作为预后良好组（71例）,3≤mRS≤6分作为预后不良组（108例）。分析两组的临床资料,包括年龄、性别、既往史、治疗前及治疗后即刻美国国立卫生研究院卒中量表（NIHSS）、Alberta卒中早期CT评分（ASPECTS）等,并进一步行多因素Logistic回归分析预后的影响因素。结果预后良好率为39.7%（71/179）。预后良好组与不良组间年龄、病前1周短暂性脑缺血发作史、NIHSS评分和溶栓前ASPECTS评分的差异均有统计学意义[分别为：（62±14）岁比（71±11）岁,8.4%（6/71）比1.9%（2/108）,（16±6）分比（19±6）分,（9.5±1.0）分比（8.5±1.9）分,均P〈0.05],其余差异均无统计学意义（均P〉0.05）。预后良好组与不良组间治疗后即刻NIHSS评分、24 h颅内出血转化率、脑实质出血率差异均有统计学意义[（10±3）分比（15±7）分,7.0%（5/71）比28.7%（31/108）,0比12.0%（13/108）,均P〈0.01]。多因素Logistic回归分析显示：年龄（OR=1.047,95%CI：1.014-1.081,P=0.005）、入院时ASPECTS评分（OR=0.382,95%CI：0.233-0.627,P〈0.01）、治疗后即刻NIHSS评分（OR=1.121,95%CI：1.050-1.196,P=0.001）为中重度脑梗死静脉溶栓联合血管内介入治疗预后的影响因素。结论年龄和治疗后即刻NIHSS评分为中重度脑梗死静脉溶栓联合血管内介入治疗预后的独立危险因素,年龄越大、治疗后即刻NIHSS评分越高,中重度脑梗死静脉溶栓联合血管内介入治疗的预后越差;入院时ASPECTS评分越高,对预后的保护性越强。
Objective To study the prognostic influencing factors for intravenous thrombolysis combined with endovaseular interventional therapy in patients with acute moderate to severe cerebral infarction. Methods From September 2013 to December 2015, the clinical data of 179 patients with moderate to severe acute cerebral infarction treated with intravenons thrombolysis combined with endovascular interventionai therapy at the Cerebrovaseular Disease Center, Shanghai Changhai Hospital were analyzed retrospectively. They were all treated with intravenous thrombolysis combined at least 1 endovascular interventional therapy （intra-arterial thrombolysis,mechanical thrombectomy or stenting） within 4.5 h after onset. The patients with mRS ≤2were divided into a good prognosis group （n=71） ,those with 3≤mBS≤6 were divided into a poor prognosis group （ n = 108） according to the modified Rankin Scale （mRS） scores after 3 months of treatment. The clinical data of both groups were analyzed,including age,sex, previous history,the National Institutes of Health Stroke Scale （NIHSS） score and Alberta stroke program early CT score （ASPECTS） immediately before and after treatment. The influencing factors of prognosis were further analyzed with multivariate Logistic regression analysis. Results The rate of good prognosis was 39.7% （71/179）. There were significant differences in age,history of transient ischemic attack at 1 week before the disease onset, the NIHSS score, and ASPECTS score before thrombolysis （ 62 ± 14 years vs. 71 ±11 years,8.4% （6/71） vs. 1.9% （2/108） ,16 ±6 vs. 19 ±6,and 9.5±1.0 vs. 8.5± 1.9,respectively; all P 〈 0. 05）. There were no significantly difference in other stroke risk factors between the 2 groups （ all P 〉 0.05）. There were significant differences in the NIHSS score immediately after treatment,24 h intracranial hemorrhage transformation, and intraparenchymal hemorrhage between the good prognosis group and the poor prognosis group （ 10 ±3 vs. 15 ±7,7.0% [5/71 ] vs. 28.7% [31/108 ] ,and 0 vs. 12.0% [ 13/108] ;all P 〈0.01）. Multivariate Logistic regression analysis showed that the age （OR, 1. 047,95% CI 1. 014- 1. 081 ;P = 0. 005 ）, NIHSS score immediately after treatment （ OR, 1. 121,95% CI 1. 050 - 1. 196 ; P = 0.001 ） were the prognostic risk factors for intravenous thrombolysis combined with endovascular interven- tioaal therapy for moderate to severe cerebral infarction. The ASPECTS on admission （ OR,0. 382,95% CI 0. 233 -0. 627 ;P 〈0. 01 ） was the protective factor. Conclusions The age and the NIHSS score immediately after treatment are the prognostic risk factors for intravenous thrombolysis combined with endovascular inter- ventional therapy for moderate to severe cerebral infarction. With the increase of age and the NIHSS score after treatment, the prognosis of patients is even worse. With the increase of ASPECTS score at admission, the prognosis is better.
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2016年第7期343-347,共5页
Chinese Journal of Cerebrovascular Diseases
关键词
卒中
缺血性卒中
血管内治疗
静脉溶栓
Alberta卒中早期CT评分
Stroke
Ischemic stroke
Endovascular treatment
Intravenous thrombolysis
Albertastroke program early computerized tomography score
