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入住重症监护病房的接受机械取栓治疗的急性缺血性中风患者的结果和功能预后

Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit.

作者信息

Viña Soria L, Martín Iglesias L, López Amor L, Astola Hidalgo I, Rodríguez García R, Forcelledo Espina L, Gonzalo Guerra J A, de Cima Iglesias S, Murias Quintana E, Vega Valdés P, Calleja Puerta S, Escudero Augusto D

机构信息

Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España; Grupo de Investigación de Microbiología traslacional del Instituto de Investigación del Principado de Asturias (ISPA), España.

Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España; Grupo de Investigación de Microbiología traslacional del Instituto de Investigación del Principado de Asturias (ISPA), España.

出版信息

Med Intensiva (Engl Ed). 2018 Jun-Jul;42(5):274-282. doi: 10.1016/j.medin.2017.07.012. Epub 2017 Nov 11.

Abstract

PURPOSE

To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke.

DESIGN

Observational prospective study.

SETTING

Mixed ICU. Third level hospital.

PATIENTS

Sixty adult patients. Consecutive sample.

INTERVENTIONS

None.

VARIABLES OF INTEREST

Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year.

RESULTS

Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year.

CONCLUSIONS

The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.

摘要

目的

研究入住重症监护病房(ICU)的急性缺血性卒中患者血管内治疗(EVT)的结果及并发症。分析与ICU出院时及卒中后一年死亡率和残疾程度相关的可能因素。

设计

观察性前瞻性研究。

地点

综合性ICU。三级医院。

患者

60例成年患者。连续样本。

干预措施

无。

感兴趣的变量

流行病学数据、症状发作至EVT的时间、血管造影结果、住院时间、机械通气天数、神经并发症、ICU入院和出院时的美国国立卫生研究院卒中量表(NIHSS)评分、一年时的改良Rankin量表评分(mRS)。

结果

平均年龄68.90±8.84岁。症状发作至EVT的中位时间:180分钟。入院时NIHSS中位数:17.5;出院时:3。90%的病例实现了远端血流。ICU中位住院时间:3天。机械通气:81.7%。一年时功能独立(mRS≤2)的患者占50%。死亡22例(36.6%),其中8例(13.3%)在ICU住院期间死亡,其余在第一年死亡。

结论

与功能结局较差相关的因素为症状性出血转化、再通失败和EVT期间的并发症。与死亡率相关的因素为症状性出血和脑积水。大多数病例实现了远端血流,并发症发生率较低。一半的患者在卒中后一年实现了功能独立。

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