目的 本研究分析影响急性脑梗死(ACI)患者颅内血管机械取栓后预后的相关因素.方法 回顾性分析 2019年 1 月至 2024 年 1 月就诊于河南省焦作市博爱县人民医院行血管内机械取栓术治疗的 60 例急性脑梗死患者的相关临床资料,根据经改良Rankin量表评估的患者术后 3 个月的预后情况分为预后良好组 34 例,预后不良组 26 例.分析两组患者一般临床资料、围手术期相关指标和术后并发症的差异,通过单因素和多因素Logistic回归分析影响颅内血管机械取栓术治疗的危重急性脑梗死患者预后的相关因素.结果 本研究两组患者既往病史中高血压、糖尿病、心房颤动存在明显差异,术前及术后 24 h NIHSS评分及ASPECT评分比较,差异有统计学意义(P＜0.05);两组患者其他临床指标比较则差异无统计学意义(P＞0.05);预后良好组手术时间明显短于预后不良组,且术后肺部感染和脑出血发生率低于预后不良组,差异有统计学意义(P＜0.05);两组患者起病到治疗时间、取栓次数、发生血栓逃逸及取栓后成功再通病例数比较,差异无统计学意义(P＞0.05);进一步经多因素Logistic回归分析发现,术后 24 h NIHSS评分、肺部感染和高血压均为患者预后不良的危险因素,而ASPECT评分为保护性因素(P＜0.05).进一步经采用受试者工作曲线(ROC曲线)分析发现 24 h NIHSS评分、ASPECT评分、高血压、肺部感染及联合使用用于预测患者预后的曲线下面积(AUC)值分别为 0.640、0.881、0.647、0.647 和 0.939,四种指标联合检测用于预测ACI患者预后的价值最高.结论 术后 24 h NIHSS评分、ASPECT评分、高血压、肺部感染均会影响颅内血管机械取栓术治疗后危重急性脑梗死患者的预后,且联合检测对患者预后的预测价值更高,临床可通过对相关指标的联合检测预测颅内血管机械取栓术后患者的预后情况.
Clinical Risk Assessment of Prognosis in Acute Cerebral Infarction Patients After Intracranial Mechanical Thrombectomy
Objective This study aims to analyze the factors influencing the prognosis of acute cerebral infarction(ACI)patients after intracranial mechanical thrombectomy.Methods A retrospective analysis was conducted on 60 patients with acute cerebral infarction who underwent endovascular mechanical thrombectomy at the People's Hospital of Bo'ai County from January 2019 to January 2024.Based on the modified Rankin Scale assessment of postoperative prognosis at 3 months,patients were divided into a good prognosis group(34 cases)and a poor prognosis group(26 cases).The differences in general clinical data,perioperative indicators,and postoperative complications between the two groups were analyzed,and univariate and multivariate logistic regression analyses were performed to identify the factors associated with prognosis in critically ill acute cerebral infarction patients undergoing mechanical thrombectomy.Results There were significant differences in the history of hypertension,diabetes,and atrial fibrillation between the two groups.The preoperative and postoperative NIHSS scores and ASPECT scores at 24 hours showed statistically significant differences(P＜0.05)while other clinical indicators did not show significant differences(P＞0.05).The surgery time in the good prognosis group was significantly shorter than that in the poor prognosis group,and the incidence of postoperative pulmonary infection and cerebral hemorrhage was lower in the good prognosis group,with significant differences(P＜0.05).There were no statistically significant differences between the two groups regarding onset-to-treatment time,number of thrombectomies,incidence of thrombus escape,and number of successful recanalizations post-thrombectomy(P＞0.05).Further multivariate logistic regression analysis revealed that postoperative NIHSS score at 24 hours,pulmonary infection,and hypertension were risk factors for poor prognosis,while ASPECT score was a protective factor(P＜0.05).Further analysis using receiver operating characteristic(ROC)curves showed the area under the curve(AUC)values for predicting prognosis were 0.640 for NIHSS at 24 hours,0.881 for ASPECT score,0.647 for hypertension,and 0.647 for pulmonary infection,with the combined use of these factors yielding the highest predictive value for patient prognosis(AUC=0.939).Conclusion The 24-hour NIHSS score,ASPECT score,hypertension,and pulmonary infection all impact the prognosis in critically ill acute cerebral infarction patients post-intracranial mechanical thrombectomy.Furthermore,combined assessments of these indicators provide greater predictive value for patient prognosis,suggesting that clinical prediction of prognosis in patients after mechanical thrombectomy can be enhanced through the joint detection of relevant indicators.
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