脑卒中机械取栓术后恶性脑水肿的发生率及危险因素的Meta分析
Meta-Analysis of the Incidence and Risk Factors of Malignant Cerebral Edema after Mechanical Embolization in Acute Ischemic Stroke
DOI: 10.12677/acm.2025.1592645, PDF,   
作者: 霍英东, 张 凤, 李珊珊, 赵 璐, 李 暘*：青岛大学附属医院神经外科重症监护室，山东 青岛
关键词: 机械取栓；脑水肿；危险因素；Meta分析；Mechanical Thrombectomy； Cerebral Edema； Risk Factors； Meta-Analysis
摘要: 目的：系统评价机械取栓术后发生恶性脑水肿的影响因素。方法：计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普网中关于脑卒中机械取栓术后发生恶性脑水肿危险因素的研究。检索时限为建库至2024年12月。提取纳入文献的资料，采用STATA17.0软件进行Meta分析。结果：共纳入17篇文献，共纳入3717例机械取栓术后的患者。Meta分析结果显示，机械取栓术后发生恶性脑水肿发生率为24.7% [95% CI (21.4%~28.1%)]。低ASPECT评分[OR = 0.73, 95% CI (0.53~1.01)]、NIHSS评分 > 15分[OR = 1.05, 95% CI (1.04~1.07)]、侧支循环[OR = 0.46, 95% CI (0.35~0.60)]、合并高血压[OR = 1.02, 95% CI (1.01~1.04)]、合并糖尿病[OR = 1.16, 95% CI (1.08~1.24)]、梗死体积[OR = 1.05, 95% CI (1.04~1.07)]、mTICI评分[OR = 0.59, 95% CI (0.47~0.74)]、蛛网膜下腔出血[OR = 7.15, 95% CI (1.94~26.3)]、颈内动脉栓塞[OR = 5.21, 95% CI (1.81~15.03)]、取栓次数[OR = 1.43, 95% CI (1.18~1.74)]是机械取栓术后发生恶性脑水肿的危险因素(P < 0.05)。结论：低ASPECT评分、NIHSS评分 > 15分、侧支循环、合并高血压、合并糖尿病、mTICI评分、蛛网膜下腔出血、颈内动脉栓塞、取栓次数、梗死体积是机械取栓术后发生恶性脑水肿的危险因素。
Abstract: Objective: To systematically evaluate the risk factors for malignant cerebral edema after mechanical thrombectomy. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, and VIP were searched for studies on the risk factors for malignant cerebral edema after mechanical thrombectomy after stroke. The search period is from the inception of the database to December 2024. The data were extracted from the literature and meta-analysis was performed using STATA17.0 software. Results: A total of 17 articles were included in a total of 3717 patients after mechanical thrombectomy. Meta-analysis showed that the incidence of malignant cerebral edema after mechanical thrombectomy was 24.7% [95% CI (21.4%~28.1%)]. Low ASPECT score [OR = 0.73, 95% CI (0.53~1.01)], NIHSS score > 15 points [OR = 1.05, 95% CI (1.04~1.07)], collateral circulation [OR = 0.46, 95% CI (0.35~0.60)], hypertension [OR = 1.02, 95% CI (1.01~1.04)], diabetes mellitus [OR = 1.16, 95% CI (1.08~1.24). Infarct volume [OR = 1.05, 95% CI (1.04~1.07)], mTICI score [OR = 0.59, 95% CI (0.47~0.74)], subarachnoid hemorrhage [OR = 7.15, 95% CI (1.94~26.3)], internal carotid artery embolism [OR = 5.21, 95% CI (1.81~15.03)], number of thrombectomy [OR = 1.43, 95% CI (1.18~1.74)]. It was a risk factor for malignant cerebral edema after mechanical thrombectomy (P < 0.05). Conclusion: Low SPECT score, NIHSS score > 15, collateral circulation, hypertension, diabetes mellitus, mTICI score, subarachnoid hemorrhage, internal carotid artery embolization, number of thrombectomy, and infarct volume are risk factors for malignant cerebral edema after mechanical thrombectomy.
文章引用：霍英东, 张凤, 李珊珊, 赵璐, 李暘. 脑卒中机械取栓术后恶性脑水肿的发生率及危险因素的Meta分析[J]. 临床医学进展, 2025, 15(9): 1458-1468. https://doi.org/10.12677/acm.2025.1592645

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