Chảy máu não triệu chứng sau can thiệp lấy huyết khối cơ học ở bệnh nhân nhồi máu não cấp=Symptomatic intracranial haemorrhage after mechanical thrombectomy in acute ischemic stroke

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Tác giả: Anh Tài Nguyễn, Gia An Phạm

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.292-298

Bộ sưu tập: Metadata

ID: 477894

Thêm vào giỏ

Chảy máu não có triệu chứng (CMNTC) là một biến chứng quan trọng trong điều trị tái thông can thiệp lấy huyết khối nội mạch (HKNM) cho bệnh nhân nhồi máu não (NMN) do tắc động mạch (ĐM) lớn và có khả năng liên quan đến tiên lượng xấu. Mục tiêu: Xây dựng mô hình dự đoán nguy cơ CMNTC sau can thiệp lấy huyết khối nội mạch ở bệnh nhân NMN do tắc ĐM lớn. Phương pháp: Phân tích dữ liệu bệnh nhân (BN) NMN do tắc ĐM lớn được chăm sóc tại Bệnh viện Chợ Rẫy bằng phương pháp lấy HKNM trong giai đoạn từ tháng 10/2023 – 02/2024 để tìm các yếu tố liên quan đến biến chứng CMNTC. Biến chứng CMNTC được chẩn đoán theo Phân loại Heidelberg trong vòng 24 giờ sau can thiệp lấy huyết khối nội mạch. Hồi quy liên kết từng bước được thực hiện để tìm mô hình dự đoán. Kết quả: Gồm 24 BN NMN do tắc ĐM lớn được điều trị tái thông lấy HKNM, trong đó 05 (20,8%) BN có biến chứng CMNTC. Các biến số như thời gian đâm kim đến khi tái thông (P=0,034), huyết áp tâm thu sau can thiệp (P=0,008), điểm NIHSS sau can thiệp (P=0,001) là các yếu tố độc lập của biến chứng CMNTC kết hợp với các biến số (huyết áp tâm thu lúc nhập viện, điểm NIHSS trước can thiệp, điểm ASPECTS, phương thức can thiệp [lấy HKNM đơn thuần hoặc kết hợp rTPA], thời gian từ khi đến bệnh viện - đâm kim), để tìm mô hình dự đoán biến chứng này. Kết luận: Mức huyết áp tâm thu lúc nhập viện dự đoán biến chứng CMNTC (diện tích dưới đường cong ROC=0,768, điểm cắt huyết áp tâm thu lúc nhập viện: 135 mmHg, độ nhạy 80%, độ chuyên biệt 64%).Symptomatic intracranial haemorrhage is an important complication of endovascular thrombectomy (EVT) for acute ischemic stroke due to large artery occlusion and is likely associated with a poor prognosis. Objectives: Develop a model to predict symptomatic intracranial haemorrhage after EVT in acute ischemic stroke due to large artery occlusion. Methods: We performed data analysis of acute ischemic stroke due to large artery occlusion who were cared for at Cho Ray Hospital by EVT in the period from October 2023 to February 2024, to find factors that associated with symptomatic intracranial haemorrhage complications. Symptomatic intracranial haemorrhage complications are diagnosed according to the Heidelberg Classification within 24 hours of EVT. Step-by step association regression is performed to find the predictive model. Results: We recorded 24 acute ischemic stroke patients due to large artery occlusion who were revascularized by EVT, of which 05 patients had complications of symptomatic intracranial haemorrhage (20.8%). Variables such as needle puncture time to revascularization (P = 0.034), post-intervention systolic blood pressure (P = 0.008), and postintervention NIHSS score (P = 0.001) were independent factors of symptomatic intracranial haemorrhage complications and were combined with systolic blood pressure variables at admission, pre-intervention NIHSS scores, ASPECTS scores, modalities of intervention (EVT alone or a combination of rtpa), and Time from arrival to hospital – needle puncture to find a model for predicting this complication. The model predicts symptomatic intracranial haemorrhage complications with 2 variables: Time from arrival to hospital - needle puncture and systolic blood pressure at admission. Conclusions: Systolic BP levels at admission predict symptomatic intracranial haemorrhage complications (area under ROC curve=0.768, systolic BP cut-off point at admission is 135 mmHg sensitivity 80%, specificity 64%).

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