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目的 探究不同时间窗机械取栓对前循环急性大血管闭塞性卒中(ALVOS)患者预后的影响。方法 回顾性分析2022年1月至2025年10月于南京医科大学康达学院附属如皋市人民医院收治的180例前循环ALVOS患者。依据机械取栓时间窗分为时间窗内组(≤6 h)与时间窗外组(>6 h)。首先比较两组患者预后情况；随后根据预后差异将全部患者分为预后良好组与预后不良组，采用单因素分析与Logistic多因素回归分析探究影响前循环ALVOS患者预后的相关因素。结果 时间窗内组患者术后改良脑梗死溶栓分级(mTICI)≥2b比例显著高于时间窗外组(χ2=6.791,P=0.009)；且时间窗内组术后美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分均低于时间窗外组(t=10.126,P=0.001;t=8.162,P=0.001)。单因素分析显示，入院NIHSS评分、症状发作至治疗时间(SOTT)、血管是否完全再通、治疗后弥散加权成像(DWI)值是否增长在不同组别患者之间的人数占比存在统计学差异(χ2=19.936、4.762、19.123、52.578，均P<0.05)。Logistic多因素回归分析提示，入院时NIHSS>21、血管未完全再通、术后DWI梗死体积增长及SOTT延长是ALVOS患者预后不良的独立危险因素。结论 发病6 h内进行机械取栓的ALVOS患者预后显著优于6 h后取栓者；入院高NIHSS评分、血管未完全再通、术后DWI梗死体积增长及SOTT延长是患者预后不良的独立危险因素。
Abstract：Objective To explore the effects of mechanical thrombectomy with different time windows on prognosis of patients with anterior circulation acute large vessel occlusive stroke(ALVOS). Methods A total of 180 patients with anterior circulation ALVOS admitted to Rugao People's Hospital Affiliated to Kangda College of Nanjing Medical University between January 2022 and October 2025 were retrospectively analyzed. According to different time window, they were divided into in-window group(≤6h) and out-windows group(>6h). Firstly, the prognosis of patients was compared between the two groups. Then, patients were divided into good prognosis group and poor prognosis group according to different prognosis. The influencing factors of prognosis in patients with anterior circulation ALVOS were explored by univariate analysis and logistic multivariate regression analysis. Results After surgery, proportion of modified thrombolysis in cerebral infarction(mTICI) grading ≥grade 2b in in-window group was significantly higher than that in out-window group(χ2=6.791, P=0.009), and scores of National Institutes of Health Stroke Scale(NIHSS) and modified ranking scale(mRS) were lower than those in outwindow group(t=10.126, P=0.001; t=8.162, P=0.001). Univariate analysis showed that there were significant differences in NIHSS score at admission, symptom onset to treatment time(SOTT), complete vascular recanalization and increase of diffusionweighted imaging(DWI) after treatment among different groups(χ2=19.936, 4.762, 19.123, 52.578, all P<0.05). It was indicated by logistic multivariate regression analysis that NIHSS score >21 points at admission, incomplete vascular recanalization, postoperative increase of DWI infarction volume and prolonged SOTT were independent risk factors of poor prognosis in ALVOS patients. Conclusions Compared with mechanical thrombectomy after onset ≥6h, mechanical thrombectomy within 6h after onset has significantly better prognosis. High NIHSS score at admission, incomplete vascular recanalization, postoperative increase of DWI infarction volume and prolonged SOTT are independent risk factors of poor prognosis.
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基本信息:
中图分类号:R743.3
引用信息:
[1]沙燕,王冬,沈海清,等.不同时间窗机械取栓对前循环ALVOS患者预后的影响[J].中华神经外科疾病研究杂志,2026,20(09):25-31.
基金信息:
江苏省医院协会医院管理创新研究课题项目（JSYGY-3-2024-378）
2026-09-08
2026-09-08