Stroke:急性缺血性脑卒中血运重建术后病情恶化的风险

2020-03-03 shaosai MedSci原创

研究证实急性缺血性脑卒中血管开放后早期恶化与良好预后具有显着相关性。然而,鲜有早期血管再通后症状恶化的研究。本研究旨在评价脑卒中24小时内血管后早期严重的潜在预测指标及远期预后。

背景与目的

研究证实急性缺血性脑卒中血管开放后早期恶化与良好预后具有显着相关性。然而,鲜有早期血管再通后症状恶化的研究。本研究旨在评价脑卒中24小时内血管后早期严重的潜在预测指标及远期预后。

方法

本研究纳入了脑血管病并行24小时内影像学检查、住院的急性脑卒中患者。开放血管后恶化定义为与入院24小时内影像学检查相比,任何颈外动脉或颈内动脉出现新发闭塞或重度狭窄。利用逐步法多元Logistic回归分析评价与血管开放后恶化相关的指标。利用改良Rankin量表评价恶化血管对发病后3个月的影响。

结果

本研究共纳入了2152例患者,共有1387 (64.5%)例患者接受经静脉溶栓和血管内治疗,有65 (3.0%)例患者发病24小时内血管开放后恶化。在多元分析中,高血压病史[aOR], 0.45; 95% CI, 0.27-0.75)可能为保护因子,而入院时NIHSS高评分(aOR, 1.06; 95% CI, 1.02-1.10)、颅内(aOR, 4.78; 95% CI, 2.03-11.25)或颅外(aOR, 3.67; 95% CI, 1.95-6.93)狭窄以及良好侧支循环功能(aOR, 3.71; 95% CI, 1.54-8.95)为血管开放后恶化为血管开放后恶化的独立预测指标。同时,也与3月改良Rankin量表评分严重不良改变具有相关性months (aOR, 5.97; 95% CI, 3.64-9.79)。

结论

脑卒中严重程度和入院血管影像学表现可能有助于识别24小时内血管开放后出现恶化高风险的患者。血管开放后恶化对远期预后的影响需要更好的方法来检出和防止早期并发症。

原始出处:

Marto JP, Lambrou D, Eskandari A, et al,Associated Factors and Long-Term Prognosis of 24-Hour Worsening of Arterial Patency After Ischemic Stroke.Stroke. 2019.DOI:10.1161/STROKEAHA.119.025787

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    2020-03-03 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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本研究的目的旨在分析和比较急性和慢性心肌损伤的远期预后。本研究纳入了2011-2014在急诊接受了高敏肌钙蛋白T(hs-cTnT)检测的22589名患者, 并将hs-cTnT>14ng/L的患者挑出来,分成急性心肌损伤、1型心梗(T1MI)、2型心梗(T2MI)或慢性心肌损伤,主要终点事件是全因死亡率。最终,共纳入分析了3853名患者,经过平均3.9年时间的随访,急性心肌损伤、1型心梗、2型心梗和

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急性自发性硬脊膜外血肿漏诊1例

患者,女,41岁,2016年9月18日凌晨2点左右出现颈后酸胀、疼痛不适,睡眠中痛醒,至我院急诊科就诊。考虑颈椎疾病,行颈椎X线检查未见明显异常;建议患者行颈椎MRI检查并留院观察,因患者及家属拒绝,故予颈托外固定、镇痛治疗,患者好转后自行回家。当日上午9点30分,患者感颈后仍疼痛难忍,再次至骨科门诊就诊。查体:神志清,精神一般,痛苦面貌,颈后叩痛、压痛,颈椎屈伸、旋转功能受限,双手霍夫曼征阴性,

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患者男,73 岁,因“全身泛发红色斑丘疹 3 个 月,加重半个月”,于 2017 年 8 月 7 日来我院就诊。 3 个月前无明显诱因自双下肢足踝处开始出现散在 红斑、丘疹,后扩散至躯干、四肢,就诊于当地医院, 查血常规(-),诊断为“过敏性皮炎”,予口服中药、 西药并外用药(具体不详)治疗半个月后,皮疹大部 分消退,留有色素沉着。半个月前皮疹再次加重,于 躯干、四肢出现多发密集的淡红色斑疹、丘疹

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由此可见,青少年的缺血性卒中强调在治疗中需要多学科协作,再通治疗似乎可行且安全。