Thay đổi huyết áp và kết quả sau can thiệp nội mạch lấy huyết khối trong nhồi máu não tắc động mạch lớn cấp tính=Changes in blood pressure and results after endovascular thrombectomy in acute large arterial occlusion cerebral infarction

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Tác giả: Hồng Minh Lê, Anh Tài Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.17-22

Bộ sưu tập: Metadata

ID: 242228

Thêm vào giỏ

Tìm mối liên quan giữa các mức huyết áp 24 giờ đầu sau can thiệp và kết cục các bệnh nhân (BN) NMN do tắc Động mạch (ĐM) lớn được can thiệp lấy HKNM. Đối tượng và phương pháp: Tiến hành phân tích kết quả điều trị tái thông bằng phương pháp lấy HKNM các BN NMN do tắc ĐM lớn (ĐM cảnh trong, ĐM não giữa, ĐM thân nền) tại Bệnh viện Chợ Rẫy (BVCR) trong quí 4 năm 2023 và các mức huyết áp (HA) duy trì trong 24 giờ đầu sau can thiệp. Các BN đủ điều kiện (≥ 18 tuổi), có HA tâm thu trong 24 giờ đầu sau khi lấy HKNM được phân chia thành các mức lần lượt <
120, 120-139, 140-159, 160-180 và >
180 mm Hg để xác định mối liên hệ với kết cục xấu hoặc tử vong (Theo thang Rankin sửa đổi 3-6 vào thời điểm 60 ngày sau xuất viện). Các biến số về HA tâm thu được đánh giá dưới dạng các biến liên tục và là biến cơ sở để phân tích. Chúng tôi sử dụng phân tích đường cong ROC để tìm khả năng dự đoán các mức HA với kết cục đánh giá vào thời điểm 60 ngày sau xuất viện. Kết quả: Từ 01/10/2023 đến 31/12/202, có 13 BN NMN do tắc ĐM lớn được điều trị tái thông bằng phương pháp lấy HKNM. Tuổi trung bình 56 ± 14, với 23,1% BN nữ và 76,9% BN nam. Thời gian trung bình kể từ khi xuất hiện các triệu chứng NMN đến nhập viện là 2 giờ 20 phút (16 phút– 4 giờ 23 phút). Độ nặng NMN được xác định bằng thang điểm NIHSS trung bình lúc nhập viện và sau lấy HKNM lần lượt là 15,67 điểm (7- 25) và 12 điểm (3-37 điểm). Các mức HA tâm thu duy trì trong 24 giờ đầu: <
120 mmHg: 38,5%, 120-139 mmHg: 30,8%, 140-159 mmHg: 23,1% và 160-180 mmHg: 7,7%. Những BN có mức HA tâm thu duy trì trong 24 giờ đầu 140 - 159 mmHg khuynh hướng có kết quả chức năng xấu hơn vào thời điểm 60 ngày sau xuất viện. Kết luận: Sau điều trị tái thông bằng phương pháp lấy HKNM, mức HA tâm thu duy trì trong 24 giờ đầu có thể dự đoán tình trạng chức năng sau xuất viện. HA tâm thu trong khoảng 140-159 mmHg có thể tiên lượng kết quả xấu với diện tích dưới đường cong ROC = 0,7. Thời gian bệnh nhân đến bệnh viện đến khi bắt đầu thực hiện lấy HKNM >
60 phút liên quan đến kết quả chức năng xấu sau 60 ngày (độ nhạy 87,5%, độ chuyên biệt 60%).To find the relationship between blood pressure levels in the first 24 hours after EVT and outcomes of AIS due to large artery occlusion. Subject and Methods: We analysed the outcomes of EVT of large occlusive AIS (internal and middle carotid and basal occlusion) at Cho Ray Hospital from 10.2023 - 12.2023 and SBP levels in the first 24 hours after EVT. Eligible patients had age ≥ 18 years old, whose SBP in the first 24 hours after EVT was divided into levels <
120, 120-139, 140-159, 160-180, and >
180 mm Hg to determine association with poor outcome or death (Revised Rankin Scale 3-6 at 60 days postdischarge). Variables in SBP are evaluated as continuous variables and are the baseline variable for analysis. We used ROC curve analysis to find the ability to predict SBP levels with poor outcome at 60 days post-discharge. Results: From 10.2023 to 12.2023, 13 AIS with large artery occlusion were revascularization by EVT. The median age was 56 ± 14, with 23.1% of female and 76.9% of male. The average time from last know well to hospitalization is 2 hours 20 minutes (16 minutes – 4 hours 23 minutes). AIS severity was determined by the mean NIHSS scale at admission and after EVT at 15.67 points (7-25) and 12 points (3-37 points), respectively. Systolic blood pressure levels maintained in the first 24 hours: <
120 mmHg: 38.5%, 120-139 mmHg: 30.8%, 140-159 mmHg: 23.1%, and 160- 180 mmHg: 7.7%. Patients with SBP levels of 140-159 mmHg tended to have worse functional outcomes at 60 days post-discharge. Conclusion: Following EVT, SBP levels maintained for the first 24 hours can predict post-discharge function - SBP between 140-159 mmHg can predict poor outcomes with area under the ROC curve = 0.7. Time to hospital arrival - initiation of EVT later than 60 minutes was associated with poor functional outcomes after 60 days post-discharge (sensitivity 87.5%, specialization 60%).

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