stroke:≥85岁急性缺血性脑卒中患者血管内治疗后的功能结果

2022-06-22 网络 网络

与保守治疗相比,≥85岁的独立病前功能患者在接受EVT治疗时更多地获得良好的功能结果,死亡率也更低。

观察性研究显示,急性缺血性卒中血管内治疗(EVT)对老年人十分有效的,尽管与年轻患者相比,其结果较差,死亡率较高。然而,目前还缺乏高龄对EVT术后效果影响的随机数据。为了评估≥85岁的缺血性卒中患者的EVT效果,以及在一个大型随机试验数据集中,年龄对结果的影响,相关研究发表在stroke杂志上。

数据来自HERMES(多个血管内卒中试验中的高效再灌注评估)合作,这是一项对2010年1月1日至2017年5月31日期间发表的7项随机试验的荟萃分析,测试了EVT的疗效。研究了年龄对治疗和结果之间的关系可能产生的互动效应。逻辑回归测试了≥85岁患者的EVT和90天功能结果(主要结果mRS)之间的关系。多变量二元逻辑回归比较了≥85岁的患者与<85岁的患者的主要和次要结果(mRS为0-2/5-6)。

在分析中纳入了1764名患者,其中77人(4.4%)的年龄≥85岁。观察到年龄和治疗对不良结局(mRS 5-6分,P=0.020)和死亡率(P=0.031)的显著交互作用。与年轻患者相比,老年人在90天内的功能结局更差(OR=0.20[95% CI,0.13-0.33])。

然而,在≥85岁的患者亚组中观察到了EVT的益处(OR=4.20[95%CI,1.56-11.32])。年龄≥85岁与症状性脑内出血或再灌注率的不同没有明显关系(OR=1.92[95%CI,0.71-5.15]和0.91[95%CI,0.40-2.06])。

与保守治疗相比,≥85岁的独立病前功能患者在接受EVT治疗时更多地获得良好的功能结果,死亡率也更低。因此,在这一亚组中不应该拒绝EVT。

 

参考文献:

Functional Outcomes of Patients ≥85 Years With Acute Ischemic Stroke Following EVT: A HERMES Substudy

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THER ADV GASTROENTER:内镜下真空治疗可促进新辅助放化疗直肠切除术后吻合口漏的愈合

新辅助放化疗(nRCT)是治疗晚期直肠癌的重要方法。内窥镜真空疗法(EVT)已成为直肠切除术后发生吻合口漏的首选治疗方法。已发表的病例系列报告平均成功率和造口逆转率超过80%。但是,到目前为止,还没有关于nRCT对EVT的潜在影响的明确报道,因此,本项研究旨在探究二者的关系