動脈內機械取栓治療急性后循環缺血性腦卒中臨床效果及預后影響因素分析

【摘要】 目的：探索動脈內機械取栓治療急性后循環缺血性腦卒中臨床效果及預后影響因素。方法：2021年2月—2022年2月納入的100例佳木斯市中心醫院神經內三科收治的急性后循環缺血性腦卒中患者，根據患者治療意愿分兩組。對照組采取靜脈溶栓，觀察組則實施動脈內機械取栓。比較兩組血管再通率、預后良好率、美國國立衛生研究院卒中量表（national institute health stroke scale，NIHSS）評分，并將觀察組分為預后良好組和預后不良組，分析預后影響因素。結果：觀察組血管再通率、預后良好率高于對照組（Plt;0.05）。手術后，觀察組NIHSS評分優于對照組（Plt;0.05）。預后良好組和預后不良組中通過多因素 logistic 回歸分析顯示，術前NIHSS 評分≥20分、發病至手術時間≥7 h、入院時后循環Alberta卒中項目早期CT評分（posterior circulation Alberta stroke program early CT score，pc-ASPECTS）lt;7分是急性后循環缺血性腦卒中患者動脈內機械取栓治療預后不良的危險因素（Plt;0.05）。結論：急性后循環缺血性腦卒中患者實施動脈內機械取栓效果確切，相對于靜脈溶栓，可更好改善患者神經功能和提高血管再通率，而影響急性后循環缺血性腦卒中患者動脈內機械取栓治療預后的因素較多，術前NIHSS 評分≥20分、發病至手術時間≥7 h、入院時pc-ASPECTS lt;7分均是其預后不良的危險因素。

【關鍵詞】 動脈內機械取栓治療 急性后循環缺血性腦卒中 美國國立衛生研究院卒中量表評分 后循環Alberta卒中項目早期CT評分

Analysis of Clinical Effect and Prognostic Factors of Intraarterial Mechanical Thrombectomy in the Treatment of Acute Posterior Circulation Ischemic Stroke/GAO Lizhi. //Medical Innovation of China， 2023， 20（31）： -152

[Abstract] Objective： To explore the clinical efficacy and prognostic factors of intraarterial mechanical thrombectomy in the treatment of acute posterior circulation ischemic stroke. Method： From February 2021 to February 2022， 100 patients with acute posterior circulation ischemic stroke admitted to the Neurology Third Department of Jiamusi Central Hospital were enrolled， and they were divided into two groups based on their treatment intentions. The control group received intravenous thrombolysis， while the observation group received intra arterial mechanical thrombectomy. The vascular recanalization rate， good prognosis rate， national institutes of health stroke scale （NIHSS） score between two groups were compared， and the observation group were divided into a good prognosis group and a poor prognosis group， and the influencing factors of prognosis was analyzed. Result： The vascular recanalization rate and good prognosis rate in the observation group were higher than those in the control group （Plt;0.05）. After surgery， the NIHSS score of the observation group was better than that of the control group （Plt;0.05）. Multivariate logistic regression analysis showed that preoperative NIHSS score ≥20 points， onset to surgery time ≥7 h， and post circulation Alberta stroke program early CT score （pc-ASPECTS） lt;7 points at admission were risk factors for poor prognosis in patients with acute post circulation ischemic stroke treated with intra arterial mechanical thrombectomy in both the good and poor prognosis groups （Plt;0.05）. Conclusion： The implementation of intra arterial mechanical thrombectomy is effective in patients with acute posterior circulation ischemic stroke. Compared to intravenous thrombolysis， it can better improve patient neurological function and increase vascular recanalization rate. There are many factors that affect the prognosis of intra arterial mechanical thrombectomy in patients with acute posterior circulation ischemic stroke. Preoperative NIHSS score of ≥20， onset to surgery time ≥7 h， and pc-ASPECTS lt;7 points at admission are all risk factors for poor prognosis.

[Key words] Intraarterial mechanical thrombectomy Acute posterior circulation ischemic stroke National institutes of health stroke scale score Posterior circulation Alberta stroke program early CT score

First-author's address： Jiamusi Central Hospital， Heilongjiang Province， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2023.31.034

腦卒中是指由于腦部血管突然破裂或因血管阻塞，造成血液無法進入大腦，從而引起腦組織損傷的一種病癥，主要有缺血性腦卒中、腦出血、蛛網膜下腔出血[1-2]。……