浙江医学2025，Vol.47Issue(14)：1500-1505,6.DOI:10.12056/j.issn.1006-2785.2025.47.14.2025-15
急性颅内大血管闭塞行分级桥接治疗患者静脉溶栓至到院时间与早期血管内治疗临床预后的关系
Association of graded bridging therapy needle-to-door time with clinical outcomes of patients with acute ischemic stroke with large vessel occlusion after early endovascular therapy
摘要
Abstract
Objective To explore the association of graded bridging therapy needle-to-door time(NDT)with the clinical prognosis of early endovascular treatment in patients with acute ischemic stroke with large vessel occlusion(AIS-LVO).Methods A total of 184 patients with AIS-LVO who were referred to Lishui Central Hospital advanced stroke center for endovascular treatment after intravenous thrombolysis at 11 primary stroke centers in Lishui from January 2020 to December 2023 were retrospectively selected.According to whether good prognosis was achieved 90 days after operation,the patients were divided into an observation group(n=84)and a control group(n=100).The general data of the two groups of patients were collected.Multivariate logistic regression analysis was used to analyze the indepedent influencing factors for good prognosis 90 days after surgery.The logistic regression fitting curves were plotted to analyze the relationship between NDT and the predicted probability of achieving a good prognosis 90 days after surgery.The ROC curve was drawn to obtain the critical value of NDT.Through univariate analysis and multivariate logistic regression analysis,the independent influencing factors of NDT and the relationship between NDT and the outcome of graded bridging therapy for AIS-LVO were clarified.Results The observation group had lower levels of systolic blood pressure at the first admission,National Institutes of Health Stroke Scale(NIHSS)score,proportion of thrombectomy by suction,and NDT compared to the control group;the proportion of arterial thrombolysis was higher than that of the control group,and the differences were all statistically significant(all P＜0.05).Multivariate logistic regression analysis showed that arterial thrombolysis and NDT of short auration were independent protective factors for achieving good prognosis 90 days after surgery,while thrombectomy by suction was an independent risk factor(all P＜0.05).According to the ROC curve,the NDT threshold was 134.5 min.The modified Rankin Scale(mRS)score of patients with NDT ≤ 134.5 min 90 days after surgery was lower than that of the NDT＞134.5 min group,while the proportion of patients with an mRS score of 0-2 at 90 days after surgery was higher than that of the NDT＞134.5 min group(both P＜0.05).There were no statistically significant differences between the NDT ≤134.5 min group and the NDT＞134.5 min group in symptomatic intracranial hemorrhage incidence and postoperative mortality rate at 90 days(both P＞0.05).The short transport distance was an independent protective factor for NDT ≤134.5 minutes group(P＜0.05).Conclusion NDT has a significant impact on the clinical prognosis of patients with AIS-LVO treated with graded bridging therapy,but does not affect the safety of endovascular treatment,which can be used as an important time management indicator for improving the treatment process of patients with AIS-LVO.关键词
急性颅内大血管闭塞/桥接治疗/时间管理/血管内治疗/预后Key words
Acute ischemic stroke with large vessel occlusion/Bridging therapy/Time control/Endovascular treatment/Prognosis引用本文复制引用
詹艳丽,李平,李珊,李一吟,钟唐晓涵,朱凯淇,蔡学礼..急性颅内大血管闭塞行分级桥接治疗患者静脉溶栓至到院时间与早期血管内治疗临床预后的关系[J].浙江医学,2025,47(14):1500-1505,6.基金项目
中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2020-R0009) （GN-2020-R0009）
浙江省医药卫生科技计划项目(2023XY259) （2023XY259）
丽水市公益技术应用研究项目(2021SJZC019) （2021SJZC019）
