目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)介入取栓治疗的预后及其影响因素。方法 选取2017-01至2019-07在医院神经内科接受介入取栓治疗的106例AIS患者,根据术后3个月患者改良Rankin评分评估预后水平,分为预后良好组和预后不良组,对两组患者各项临床资料进行分析,对比预后的相关因素及危险因素,并对认知功能和预后血清神经相关因子表达水平进行对比。结果 患者年龄大、合并冠心病、术前血清CRP及Hcy高、阻塞血管再通时间较长、术后36 h存在部分再通均为AIS介入治疗预后不良的危险因素(OR>1,P<0.05);预后良好组的认知功能、运动功能、语言功能均优于预后不良组,差异有统计学意义(P<0.05);两组患者吞咽功能差异无统计学意义。预后良好组血清神经相关因子表达水平均优于预后不良组,差异有统计学意义(P<0.05)。结论 预后良好AIS患者各项功能与血清神经相关因子表达水平状态均较好,对年龄较大、发病至就诊时间较长、合并冠心病,且术前血清CRP、Hcy、NIHSS评分偏高,阻塞血管再通时间较长及术后36 h内仅达到部分再通的患者应给予充分重视,对危险因素积极预防,提高预后水平。
Abstract
Objective To explore the prognosis and influencing factors of interventional thrombectomy in the treatment of acute ischemic stroke (AIS).Methods The subjects were 106 patients with AIS who received interventional thrombectomy in the Department of Neurology in our hospital between January 2017 and July 2019. The level of prognosis of the included patients was evaluated based on the modified Rankin score three months postoperatively. These patients were divided into the good prognosis group and poor prognosis group to analyze all the clinical data. Furthermore, prognosis-related factors and corresponding risk factors were analyzed while cognitive function and expression levels of serum nerve related factors were compared between the two groups.Results Old age, complications with coronary heart disease, high preoperative levels of serum CRP and Hcy, long recanalization of blocked vessels and partial recanalization 36 h after operation were all risk factors for poor prognosis of interventional thrombectomy for AIS (OR>1, P<0.05). The cognitive function, motor function and language function of the good prognosis group were better than those of the poor prognosis group, with statistically significant difference (P<0.05), but there was no statistically significant difference in the swallowing function between the two groups. In addition, the expression levels of serum nerve related factors in the good prognosis group were better than those of the poor prognosis group, with statistically significant difference (P<0.05).Conclusions AIS patients with good prognosis have better functions and expression levels of serum nerve related factors.Patients who are older, have a long onset-to-treatment time, are complicated with coronary heart disease, have high preoperative serum levels of CRP, Hcy and NIHSS scores, or take a long time have their blocked vessels recanalized or partially recanalized within 36 h of operation deserve more attention, and risk factors should be prevented to improve the prognosis of patients.
关键词
急性 /
缺血性 /
脑卒中 /
介入治疗 /
预后
Key words
acute /
ischemia /
stroke /
interventional therapy /
prognosis
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