Lin Meng-Ting, Wu Hao-Wei, Chen Hsing-Yu, Tsai Hsiao-Ting, Wu Chueh-Hung
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
J Formos Med Assoc. 2023 Apr;122(4):344-350. doi: 10.1016/j.jfma.2022.11.016. Epub 2022 Dec 10.
BACKGROUND/PURPOSE: Multiple clinical factors have been reported to be associated with functional outcomes in patients with stroke. However, little is known about prognostic predictors of functional independence in patients with stroke undergoing endovascular thrombectomy (EVT). Our study aimed to investigate the correlation between multiple prognostic variables (including EVT and rehabilitation-related parameters) and functional outcomes in patients post-EVT.
This retrospective cohort study recruited patients hospitalized between December 2018 and March 2022. Patients with stroke with large-vessel occlusion who underwent EVT were eligible for inclusion in the study. Prognostic factors, including premorbid characteristics, laboratory data, EVT- and rehabilitation-related parameters, functional activity level, balance ability, swallowing, and sphincter function, were collected. Logistic regression and generalized linear models were used to analyze their correlations with functional outcomes.
A total of 148 patients were included. In the univariate logistic regression analysis, younger age, premorbid functional independence, higher hemoglobin (Hb) level, lower National Institute of Health Stroke Scale (NIHSS) score, absence of hemorrhagic transformation in 14 days, no nasogastric (NG) tube placement, earlier rehabilitation, frequent daily rehabilitation sessions, more out-of-bed rehabilitation, better ability of sitting up, better initial sitting balance, higher Barthel index (BI), absence of immobility, and neurological complications were associated with favorable outcomes at 3 months. In the stepwise regression model, the predictors of favorable function at 3 months included age, ability to sit up, and frequency of daily rehabilitation sessions; favorable outcomes at 6 months were associated with age, ability to sit up, and swallowing function.
In patients with stroke post-EVT, better functional outcomes were associated with prognostic variables, including younger age, better ability to sit up, normal swallowing function, and frequent daily rehabilitation sessions.
背景/目的：已有多项临床因素被报道与卒中患者的功能结局相关。然而，对于接受血管内血栓切除术（EVT）的卒中患者功能独立的预后预测因素知之甚少。我们的研究旨在调查多种预后变量（包括EVT和康复相关参数）与EVT术后患者功能结局之间的相关性。
这项回顾性队列研究纳入了2018年12月至2022年3月期间住院的患者。患有大血管闭塞且接受EVT的卒中患者符合纳入本研究的条件。收集了预后因素，包括病前特征、实验室数据、EVT和康复相关参数、功能活动水平、平衡能力、吞咽及括约肌功能。采用逻辑回归和广义线性模型分析它们与功能结局的相关性。
共纳入148例患者。在单因素逻辑回归分析中，年龄较小、病前功能独立、血红蛋白（Hb）水平较高、美国国立卫生研究院卒中量表（NIHSS）评分较低、14天内无出血转化、未放置鼻胃管（NG）、康复较早、每日康复次数频繁、更多的床旁康复、坐起能力较好、初始坐位平衡较好、Barthel指数（BI）较高、无运动障碍及神经并发症与3个月时的良好结局相关。在逐步回归模型中，3个月时功能良好的预测因素包括年龄、坐起能力和每日康复次数；6个月时的良好结局与年龄、坐起能力和吞咽功能相关。
在接受EVT的卒中患者中，较好的功能结局与预后变量相关，包括年龄较小、坐起能力较好、吞咽功能正常及每日康复次数频繁。
