| 尤成浩,杨运周,邵亚兰,等.脑血流动力学参数预测急性前循环大血管闭塞性卒中病人血管内治疗后转归[J].安徽医药,2026,30(7):1370-1375. |
| 脑血流动力学参数预测急性前循环大血管闭塞性卒中病人血管内治疗后转归 |
| Cerebral hemodynamic parameters for predicting the outcome of endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke |
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| DOI：10.3969/j.issn.1009-6469.2026.07.020 |
| 中文关键词: 脑梗死 经颅骨多普勒超声 血管内治疗 脑血流动力学参数 预后转归 |
| 英文关键词: Brain infarction Transcranial Doppler sonography Endovascular therapy Hemodynamic parameters Prognostic regression |
| 基金项目:六安市科技计划项目( 2024lakj015) |
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| 中文摘要: |
| 目的探讨早期行经颅多普勒超声( TCD)监测脑血流动力学参数对急性前循环大血管闭塞性卒中病人血管内治疗(EVT)后转归的预测价值。方法回顾性纳入 2022年 1月至 2024年 3月在安徽医科大学附属六安医院卒中中心接受 EVT治疗的急性前循环大血管闭塞性卒中病人。 EVT后 24 h内完善 TCD检查，监测脑血流动力学参数并记录相关指标:收缩期峰值流速( PSV)、平均峰值流速( MV)、搏动指数( PI)等；为排除个体间差异，引入患侧( i)及健侧( c)大脑中动脉 PSV和 MV，计算患侧与健侧大脑中动脉的 PSV比值( PSViMCA/PSVcMCA)及 MV比值( MViMCA/MVcMCA)。在发病后 90 d根据改良 Rankin量表( mRS)评分将所有病人分为预后良好组( mRS≤2分)和预后不良组( mRS>2分)。应用多变量 logistic回归分析 EVT后转归的独立相关因素。采用受试者操作特征曲线(ROC曲线)评估脑血流动力学参数对预后转归不良的预测价值。结果共纳入 106例病人，性 55例( 51.87%)中位年龄 70岁(范围 61~75岁)61例( 57.55%)发生了预后转归不良。预后不良组的 PI(104.84±22.71比男87.09±16.32)和PSV，比值( 126.02±22.39比 109.85±21.5，9)均高于预后良好组( P<0.001)。多变量 logistic回归分析显示， PI优势比( OR)95%CI:1.06(1.03，1.10)、 PSV比值 OR 95%CI为 1.04(1.01，1.08)、基线美国国立卫生研究院卒中量表( NIHSS)评分 OR95%CI为 1.76(1.33，2.33)升高以及基线阿尔伯特卒中项目早期 CT(ASPECTS)评分 OR 95%CI为 0.51(0.29，0.90)降低是预后转归不良的独立预测因素。 ROC曲线分析显示，脑血流动力学参数 PI和 PSV比值预测预后不良转归的曲线下面积及其 95%CI分别为 0.73(0.64，0.82)和 0.70(0.60，0.81)，联合预测的曲线下面积是 0.79(0.71，0.88)。同时，再联合其他临床参数后预测效也显著提高。结论脑血流动力学参数对 EVT后转归不良具有一定的预测价值，尤其 PI等参数联合预测时，具有更好的预测价值。 |
| 英文摘要: |
| Objective To investigate the predictive value of early transcranial Doppler sonography (TCD) monitoring of cerebral he-modynamic parameters in patients with acute anterior circulation large vessel occlusion stroke after endovascular therapy (EVT).Meth. ods Patients with acute anterior circulation large vessel occlusive stroke who received EVT at the Stroke Center of Lu'an Hospital Af-filiated with Anhui Medical University from January 2022 to March 2024 were retrospectively included in this study. A complete TCDexamination was performed within 24 hours after EVT; additionally, cerebral hemodynamic parameters were monitored, and related in-dicators such as peak systolic velocity (PSV), mean peak velocity (MV), and the pulsatility index (PI) were recorded. To exclude individ-ual differences, the PSV and MV of the middle cerebral artery on the affected side (i) and the healthy side (c) were measured, and thePSV ratio (PSViMCA/PSVcMCA) and MV ratio (MViMCA/MVcMCA) of the middle cerebral artery on the affected side and the healthy side werecalculated. According to the modified Rankin Scale (mRS) score, all of the patients were categorized into a good prognosis group (mRS≤2) and a poor prognosis group (mRS>2) at 90 days postsurgery. Multivariate logistic regression analysis identified the independent fac-tors associated with the outcome after EVT. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value ofcerebral hemodynamic parameters for poor outcomes.Results A total of 106 patients were included in the analysis, including 55 males(51.87%). The median age of the patients was 70 years (range: 61–75 years), and 61 patients (57.55%) exhibited poor prognoses. In the poor-prognosis group, both the PI (104.84 ± 22.71 vs. 87.09 ± 16.32) and the PSV ratio (126.02 ± 22.39 vs. 109.85 ± 21.59) were higher than those in the good-prognosis group (P < 0.001). Multivariate logistic regression analysis revealed that the PI [odds ratio (OR) = 1.06, 95% confidence intervals (CI):(1.03,1.10), PSV ratio OR = 1.04, 95%CI:(1.01,1.08), baseline National Institutes of health stroke scale (NIHSS) score OR = 1.76, 95%CI:(1.33,2.33), and baseline Alberta stroke program early CT score (ASPECTS) OR = 0.51, 95%CI:(0.29,0.90), were independent predictors of poor prognosis. ROC curve analysis revealed that the area under the curve (AUC) values and95%CI of the cerebral hemodynamic parameters PI and PSV ratio for predicting poor prognosis were 0.73(0.64,0.82), and 0.70 (0.60,0.81), respectively. Moreover, the AUC value and 95%CI of the combined prediction was 0.79 (0.71,0.80). Additionally, the predictionefficiency increased when additional clinical factors were combined.Conclusion Cerebral hemodynamic parameters demonstrate par-ticular predictive value for poor outcomes after EVT, especially when the PI and other parameters are combined for prediction. |
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