急性缺血性脑卒中伴心房颤动患者行 机械取栓的临床疗效及预后因素

Clinical Efficacy and Prognostic Factors of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Atrial Fibrillation

摘要:

〔摘 要〕 目的：研究机械取栓治疗急性缺血性脑卒中（AIS）伴心房颤动患者的疗效及预后因素。 方法：选取北 京市红十字会急诊抢救中心 2020 年 2 月至 2021 年 12 月期间收治的 90 例 AIS 伴心房颤动患者，均行机械取栓治疗， 入院时、治疗后 24 h、7 d、90 d 评估患者的美国国立卫生研究院卒中量表（NIHSS）评分，并在治疗 90 d 后评估患 者的预后效果，参考改良 Rankin 修订量表（mRS）评价，并对影响预后的危险因素总结分析。 结果：入院时所有患 者 NIHSS 评分为（11.25 ± 2.34）分，治疗后 24 h 的 NIHSS 评分为（8.21 ± 1.52）分，治疗后 7 d 的 NIHSS 评分为 （5.12 ± 0.93）分，治疗后 90 d 的 NIHSS 评分为（3.06 ± 0.54）分，NIHSS 评分逐渐下降，差异具有统计学意义 （P ＜ 0.05）。预后良好组、预后不良组患者比较，年龄、高血压、糖尿病、血糖、收缩压、舒张压、侧支循环建立情况、 开始治疗时间、血管再通时间及入院 NIHSS 评分比较，差异具有统计学意义（P ＜ 0.05）；多因素 logistic 回归分析 显示，导致 AIS 伴心房颤动患者机械取栓术后预后不良的独立危险因素有：年龄≥ 60 岁、高血压、未建立侧支循环、 血管再通时间≥ 4 h、入院 NIHSS 评分≥ 14 分，差异具有统计学意义（P ＜ 0.05）。 结论：机械取栓术治疗 AIS 伴 心房颤动患者可减缓神经功能缺损程度，导致患者预后不良的独立危险因素是年龄≥ 60 岁、高血压、未建立侧支循环、 血管再通时间≥ 4 h、入院 NIHSS 评分≥ 14 分，故临床需引起高度重视。

Abstract:

〔Abstract〕 Objective To investigate the efficacy and prognostic factors of mechanical thrombectomy in patients with acute ischemic stroke (AIS) and atrial fibrillation. Methods A total of 90 patients with AIS and atrial fibrillation admitted to the Emergency Rescue Center of Beijing Red Cross Society from February 2020 to December 2021 were selected. All patients underwent mechanical thrombus removal. The score of the National Institutes of Health Stroke Scale (NIHSS) was assessed upon admission,24 h, 7 d, and 90 d after treatment. After 90 days of treatment, the prognostic effect was evaluated by referring to the Modified Rankin Modified Scale (mRS), and the risk factors affecting the prognosis were summarized and analyzed. Results The NIHSS score of all patients was (11.25 ± 2.34) points at admission, (8.21 ± 1.52) points at 24 h after treatment, and (5.12 ± 0.93) points at 7 d after treatment. The NIHSS score at 90 days after treatment was (3.06 ± 0.54), and the NIHSS score decreased gradually, the difference were statistically significant (P < 0.05). Age, hypertension, diabetes, blood glucose, systolic blood pressure, diastolic blood pressure, establishment of collateral circulation, time to start treatment, vascular recanalization time and NIHSS score on admission were compared between the good prognosis group and the poor prognosis group, and the differences were statistically significant (P < 0.05). Multivariate logistic regression analysis showed that independent risk factors for poor prognosis in AIS patients with atrial fibrillation after mechanical thrombation were age ≥ 60 years old, hypertension, failure to establish collateral circulation, vascular recanalization time ≥ 4 h, and NIHSS ≥ 14 points on admission, with statistical significance (P < 0.05). Conclusion Mechanical thrombectomy in AIS patients with atrial fibrillation can reduce the degree of neurological impairment. Independent risk factors leading to poor prognosis of patients are age ≥ 60 years old, hypertension, failure to establish collateral circulation, vascular recanalization time ≥ 4 h, and NIHSS score at admission ≥ 14 points. Therefore, clinical attention should be paid to these factors.