急性大血管闭塞机械取栓后出血转化的危险因素分析及风险预测模型建立

目的 探讨急性大血管闭塞机械取栓后出血转化的危险因素及风险预测模型的建立。 方法 选取蚌埠医学院第二附属医院2017年2月—2019年11月间急性大血管闭塞支架取栓后血管成功再通的患者110例,根据有无颅内出血分为出血组(30例)和非出血组(80例),统计2组一般临床资料、影像学资料和手术相关资料,对收集的资料进行单因素分析和多因素logistic回归分析。 结果 单因素分析结果显示:饮酒、抗血小板、闭塞血管、造影剂渗出、OTR值、PTR值、ASPECT评分、术后24 h NIHSS评分等指标在2组之间差异有统计学意义(均P<0.05),桥接治疗(P=0.773)不增加机械取栓术后出血转化的风险;多因素logistic回归分析显示:替罗非班(P=0.107)的应用不增加急性大血管闭塞机械取栓术后出血转化的风险,大脑中动脉闭塞(OR=24.130,P=0.030)、PTR过长(OR=0.555,P=0.008)为危险因素,ASPECT评分(OR=0.345,P=0.001)为保护因素,且急性脑梗死机械取栓术后颅内是否出血主要取决于ASPECT评分,其次为是否发生大脑中动脉闭塞,最后为PTR值的大小。 结论 大脑中动脉闭塞、ASPECT评分、PTR为急性脑梗死机械取栓术后颅内出血转化的独立影响因素。 

Analysis of risk factors for hemorrhage transformation and establishment of risk prediction model after mechanical thrombectomy in acute large vessel occlusion

Objective To explore the risk factors and the establishment of a risk prediction model for the hemorrhagic transformation after mechanical thrombectomy in acute large vessel occlusion. Methods A total of 110 patients with successful recanalization of responsible blood vessels after stent embolization from acute large vessel occlusion in Second Affiliated Hospital of Bengbu Medical College from February 2017 to November 2019 were selected and divided into a bleeding group and a non-bleeding group. Among them, 30 cases of the bleeding group and 80 cases of the non-bleeding group, the general clinical data, imaging data and operation related data of the two groups were counted. The collected data were analyzed by single factor analysis and multiple factor logistic regression analysis. Results The results of single factor analysis showed that the drinking habits, antiplatelet, occluded vessels, whether the contrast agent oozes out, time from onset to recanalization(OTR), time from puncture to recanalization(PTR), early CT score of Alberta stroke project(ASPECT), the National Institutes of Health Stroke Scale(NIHSS) score 24 h after surgery had statistical difference between the two groups(P<0.05). Multi-factor analysis results showed that middle cerebral artery occlusion(OR=24.130, P=0.030), PTR(OR=0.555, P=0.008) were risk factors, and the ASPECT score(OR=0.345, P=0.001) was the protective factor, and whether intracranial hemorrhage after mechanical thrombectomy for acute cerebral infarction mainly depended on the ASPECT score, followed by whether the brain occurs middle arterial occlusion, and finally PTR size. Conclusion Middle cerebral artery occlusion, ASPECT score and PTR are independent influencing factors of intracranial hemorrhage after mechanical thrombectomy for acute cerebral infarction.