摘要：

目的: 探讨急性前循环大面积梗死患者血管内机械取栓术后亚低温治疗的有效性和安全性。方法: 纳入河南省人民医院2023年1月至2024年8月收治的82例急性前循环大面积梗死患者，均行机械取栓术且术后血管再通，41例术后立即接受目标核心温度33~34℃、持续48~72 h的亚低温治疗（低温治疗组），余41例未行亚低温治疗（机械取栓组）。术后72 h测定血清神经元特异性烯醇化酶（NSE）水平；出院后3个月采用改良Rankin量表评估预后，记录预后良好率和病死率，以及机械取栓术后住院期间的并发症发生率。采用单因素和多因素Logistic回归分析筛查急性前循环大面积梗死患者机械取栓术后预后的影响因素。结果: 低温治疗组术后72 h血清NSE水平低于机械取栓组[18.86（13.35，30.54）μg/L对21.43（18.30，32.90）μg/L；Z=-2.147，P=0.032]，出院后3个月预后良好率高于机械取栓组[46.34%（19/41）对21.95%（9/41）；χ²=5.423，P=0.020]，而两组病死率（χ²=0.734，P=0.391）以及住院期间出血性转化（χ²=0.497，P=0.481）、血管再闭塞（χ²=0.945，P=0.331）、恶性脑水肿（χ²=1.058，P=0.304）、肺部感染（χ²=2.614，P=0.106）、电解质紊乱（χ²=1.222，P=0.269）、心律失常（χ²=0.456，P=0.499）、深静脉血栓（χ²=0.311，P=0.577）、凝血功能异常（χ²=1.246，P=0.264）发生率差异无统计学意义。Logistic回归分析显示，亚低温治疗是急性前循环大面积梗死机械取栓术后预后良好的保护因素（OR=4.457，95% CI：1.503~13.759；P=0.007），年龄增长（OR=0.915，95% CI：0.856~0.978；P=0.009）、既往有高血压（OR=0.175，95% CI：0.055~0.562；P=0.003）是预后不良的危险因素。结论: 急性前循环大面积梗死患者机械取栓术后亚低温治疗安全、可行，减少NSE释放可能是其发挥作用的途径之一，尚待大样本随机对照试验进一步验证其疗效。

关键词: 缺血性卒中, 血栓切除术, 低温，人工, 神经保护, 预后, 危险因素, Logistic模型

Abstract:

Objective: To explore the efficacy and safety of mild hypothermia therapy in patients with acute anterior circulation massive cerebral infarction after endovascular mechanical thrombectomy. Methods: Eighty-two patients with acute anterior circulation massive cerebral infarction admitted to He'nan Provincial People's Hospital from January 2023 to August 2024, who underwent mechanical thrombectomy, were included. Hypothermia group (n = 41) received mild hypothermia therapy with a target core temperature of 33-34 ℃ for 48-72 h immediately after surgery, and the others didn't (mechanical thrombectomy group, n = 41). Serum neuron-specific enolase (NSE) levels were measured 72 h after operation; prognosis was assessed using the modified Rankin Scale (mRS) at 3 months after discharge, and good prognosis and morbidity and mortality rates were recorded; as well as the complication rates were recorded during hospitalization after surgery. Univariate and multivariate Logistic regression analyses were used to screen for factors influencing prognosis after mechanical thrombectomy in patients with acute anterior circulation massive cerebral infarction. Results: The serum NSE level at 72 h after operation in the hypothermia group was lower than the mechanical thrombectomy group [18.86 (13.35, 30.54) μg/L vs. 21.43 (18.30, 32.90) μg/L; Z =-2.147, P = 0.032], and the good prognosis rate at 3 months after discharge was higher than the mechanical thrombectomy group [46.34% (19/41) vs. 21.95% (9/41); χ² = 5.423, P = 0.020], and the mortality rate (χ² = 0.734, P = 0.391), incidence of hemorrhagic transformation (χ² = 0.497, P = 0.481), vascular reocclusion (χ² = 0.945, P = 0.331), malignant brain edema (χ² = 1.058, P = 0.304), pulmonary infection (χ² = 2.614, P = 0.106), electrolyte disturbance (χ² = 1.222, P = 0.269), arrhythmia (χ² = 0.456, P = 0.499), deep venous thrombosis (χ² = 0.311, P = 0.577), and abnormal coagulation function (χ² = 1.246, P = 0.264) during hospitalization between the 2 groups were not statistically significant. Logistic regression analysis showed that mild hypothermia was a protective factor for good prognosis after mechanical thrombectomy for acute anterior circulation massive cerebral infarction (OR = 4.457, 95%CI: 1.503-13.759; P = 0.007), while age increase (OR = 0.915, 95%CI: 0.856-0.978; P = 0.009), history of hypertension (OR = 0.175, 95%CI: 0.055-0.562; P = 0.003) were risk factors for poor prognosis. Conclusions: Mild hypothermia after mechanical thrombectomy in patients with acute anterior circulation massive cerebral infarction is safe and feasible. Reducing NSE release may be one of its action pathways, and large-scale randomized controlled trials are needed to further verify its efficacy.

Key words: Ischemic stroke, Thrombectomy, Hypothermia, induced, Neuroprotection, Prognosis, Risk factors, Logistic models