서 론
1. 연구의 필요성
연구 방법
2. 연구 대상
3. 연구 도구
1) 일반적 특성
2) 임상적 특성
3) 치료적 특성
4. 자료수집
5. 자료 분석
연속성 변수 중 Shapiro-Wilk test로 정규성 검정을 시행한 결과 정규성을 만족하지 않는 값은 중앙값과 범위로 나타내었고, 뇌재관류 손상 발생군과 비발생군의 차이를 비교하기 위하여 비모수 방법인 Mann-Whitney U test를 이용하였다. 정규성을 만족한 변수는 평균과 표준편차로 나타내었고, t-test를 이용하여 분석하였다.
비연속성 변수는 빈도와 백분율로 나타내었고, 두 군의 차이를 비교하기 위해 chi-square test와 Fisher’s exact test로 분석하였다.
뇌재관류 손상과 관련된 위험요인은 로지스틱 회귀분석으로 분석하였다. 변수선택은 backward elimination 방법으로 하였다.
뇌재관류 손상의 여부에 따른 임상결과의 차이는 chi-square test와 t-test로 분석하였다.
연구 결과
1. 대상자의 일반적 특성
Table 1.
Characteristics | Total (N=168) | Non-Injury (n=101) | Injury (n=67) | χ2, t or Z |
---|---|---|---|---|
|
||||
n (%) or M±SD or Median (IQR) | ||||
|
||||
Sex | ||||
Male | 106 (63.1) | 69 (68.3) | 37 (55.2) | 2.97 |
Female | 62 (36.9) | 32 (31.7) | 30 (44.8) | |
Age (yr) | 72 (64-80) | 69 (62-76) | 76 (68-81) | -3.84 |
BMI (kg/m2) | 23.42±3.09 | 23.53±3.07 | 23.80±3.64 | -0.31 |
Current or former smoker | 69 (41.1) | 47 (46.5) | 22 (32.8) | 3.12 |
Current or former alcohol intake | 77 (45.8) | 56 (55.4) | 21 (31.3) | 9.43 |
Comorbidities‡ | ||||
Hypertension | 100 (59.5) | 55 (54.5) | 45 (67.2) | 2.70 |
DM | 45 (26.8) | 25 (24.8) | 20 (29.9) | 0.53 |
Hyperlipidemia | 35 (20.8) | 24 (23.8) | 11 (16.4) | 1.32 |
Heart disease | 47 (28.0) | 28 (27.7) | 19 (28.4) | 0.01 |
Cancer | 27 (16.1) | 16 (15.8) | 11 (16.4) | 0.01 |
Family history | 21 (12.5) | 12 (11.9) | 9 (13.4) | 0.09 |
Stroke history | 49 (29.2) | 27 (26.7) | 22 (32.8) | 0.73 |
2. 대상자의 임상적 및 치료적 특성
Table 2.
Characteristics | Total (N=168) | Non-Injury (n=101) | Injury (n=67) | χ2 or Z | p |
---|---|---|---|---|---|
|
|||||
n (%) or M±SD or median (IQR) | |||||
|
|||||
SBP (mmHg) | 142 (127-162) | 139 (126-161) | 146 (127-166) | -1.28 | .201† |
DBP (mmHg) | 78 (70-89) | 78 (69-90) | 79 (70-88) | -0.31 | .755† |
Laboratory blood test | |||||
Glucose (mg/dL) | 130.50 (112.00-157.00) | 129.00 (110.00-151.00) | 135.00 (113.00-183.00) | -0.94 | .350† |
HbA1c (%) | 5.80 (5.50-6.50) | 5.80 (5.50-6.25) | 5.80 (5.60-6.90) | -1.03 | .301† |
PLT (×103/uL) | 205(166-268) | 204 (166-271) | 206 (174-249) | -0.16 | .874† |
INR | 1.04 (1.00-1.11) | 1.04 (1.00-1.10) | 1.04 (0.99-1.13) | -0.25 | .807† |
aPTT (sec) | 25.70 (24.05-28.60) | 26.30 (24.70-28.60) | 25.10 (23.40-28.20) | -1.97 | .049† |
BUN (mg/dL) | 17 (13-21) | 16 (12-19) | 20 (15-27) | -3.98 | <.001† |
Cr (mg/dL) | 0.96 (0.80-1.14) | 0.92 (0.74-1.10) | 0.99 (0.88-1.28) | -2.96 | .003† |
LDL (mg/dL) | 110.65±38.06 | 111.89±38.98 | 104.30±42.44 | 0.85 | .398 |
NIHSS | |||||
Baseline | 12.95±6.18 | 12.66±6.68 | 13.39±5.36 | -0.74 | .459 |
After intervention (n=126) | 9.42±6.48 | 8.56±6.94 | 11.67±6.00 | -2.56 | .012 |
1st day at ICU (n=124) | 8.27±6.54 | 7.22±6.61 | 9.98±6.02 | -2.33 | .022 |
mRS (Baseline) | 4 (4-5) | 3 (3-4) | 4 (4-5) | -1.85 | .064† |
FLAIR change | 62 (37.6) | 35 (35.4) | 27 (40.9) | 0.52 | .470 |
Artificial airway | 14 (8.3) | 10 (9.9) | 4 (6.0) | 0.82 | .367 |
Medication | |||||
Antiplatelet | 39 (23.2) | 23 (22.8) | 16 (23.9) | 1.03 | .310 |
Anticoagulation | 29 (17.3) | 15 (14.9) | 14 (20.9) | 0.09 | .766 |
TOAST | |||||
LAA | 41 (24.4) | 26 (25.7) | 15 (22.4) | 1.86 | .603 |
CE | 97 (57.7) | 55 (54.5) | 42 (62.7) | ||
SVO | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
Other | 9 (5.4) | 5 (5.0) | 4 (6.0) | ||
UD | 21 (12.5) | 15 (14.9) | 6 (9.0) | ||
Neurologic symptom | |||||
None | 42 (25.0) | 34 (33.7) | 8 (11.9) | 10.44 | .015 |
Aphasia | 74 (44.0) | 40 (39.6) | 34 (50.7) | ||
Anosognosia | 39 (23.2) | 21 (20.8) | 18 (26.9) | ||
Aphasia and anosognosia | 13 (7.8) | 6 (5.9) | 7 (10.4) | ||
NPi decrease (n=49) | |||||
Right | 23 (30.7) | 12 (29.3) | 11 (32.4) | 0.08 | .773 |
Left | 26 (34.7) | 14 (34.1) | 12 (35.3) | 0.01 | .917 |
Target SBP (mmHg) | |||||
SBP ≤140 | 48 (28.6) | 32 (31.7) | 16 (23.9) | 3.61 | .165 |
SBP 141-160 | 93 (55.4) | 50 (49.5) | 43 (64.2) | ||
SBP >160 | 27 (16.1) | 19 (18.8) | 8 (11.9) | ||
SBP difference (Highest-Target) | 12.69±22.03 | 8.64±22.80 | 18.79±19.43 | -2.99 | .003 |
Time required to retain the target SBP for 3 consecutive times (min) | 56 (0-225) | 32 (0-151) | 90 (44-315) | -3.08 | .002† |
Times the target SBP was exceeded | 2 (0-3) | 1 (0-3) | 2 (1-4) | -3.08 | .002† |
Application of restraint | 79 (47.0) | 42 (41.6) | 37 (55.2) | 3.01 | .083 |
RASS | |||||
≥1 | 30 (17.9) | 15 (14.9) | 15 (22.4) | 1.56 | .212 |
<1 | 138 (82.1) | 86 (85.1) | 52 (77.6) |
aPTT=activated partial thromboplastin time; BUN=Blood urea nitrogen; CE=Cardioembolism; Cr=Creatinine; DBP=Diastolic blood pressure; FLAIR=Fluid attenuated inversion recovery; HbA1c=Hemoglobin A1c; ICU=Intensive care unit; INR=International normalized ratio; IQR=Inter quartile range; LAA=Large-atery atherosclrosis; LDL=Low density lipoprotein; MRI=Magnetic resonance image; mRS=modified Rankin Scale; NIHSS=National Institute of Health Stroke scale; NPi=Neurological pupil index; PLT=Platelet; RASS=Richmond agitation sedation scale; TOAST=Trial of ORG 10172 in Acute Stroke Treatment; SBP=Systolic blood pressure; SVO=Small vessel occlusion; UD=Undetermined etiology.
Table 3.
Characteristics | Total (N=168) | Non-Injury (n=101) | Injury (n=67) | χ2 or Z | p |
---|---|---|---|---|---|
|
|||||
n (%) or Median (IQR) | |||||
|
|||||
IV-rTPA | 41 (24.4) | 26 (25.7) | 15 (22.4) | 0.25 | .620 |
Aspirin | 41 (24.4) | 26 (25.7) | 15 (22.4) | 0.25 | .620 |
Clopidogrel | 29 (17.3) | 19 (18.8) | 10 (14.9) | 0.43 | .514 |
Heparin | 3 (1.8) | 1 (1.0) | 2 (3.0) | - | .584† |
Tirofiban | 7 (4.2) | 4 (4.0) | 3 (4.5) | - | 1.000† |
LNT to needle time (min) | 408 (193-845) | 455 (202-840) | 365 (180-885) | -0.57 | .569‡ |
Procedure duration (min) | 70 (55-94) | 69 (55-91) | 80 (55-98) | -0.76 | .448‡ |
Type of device | |||||
Stentriever | 67 (39.9) | 38 (37.6) | 29 (43.3) | 1.09 | .580 |
Aspiration | 59 (35.1) | 35 (34.7) | 24 (35.8) | ||
Both | 42 (25.0) | 28 (27.7) | 14 (20.9) | ||
PTA | 23 (13.7) | 13 (12.9) | 10 (14.9) | 0.14 | .705 |
Reperfusion | |||||
Successful | 138 (82.1) | 81 (80.2) | 57 (85.1) | 0.65 | .419 |
Partial | 30 (17.9) | 20 (19.8) | 10 (14.9) | ||
Vessel of occlusion | |||||
ICA | 30 (17.9) | 20 (19.8) | 10 (14.9) | 3.14 | .371 |
MCA | 98 (58.3) | 56 (55.4) | 42 (62.7) | ||
VBA | 27 (16.1) | 19 (18.8) | 8 (11.9) | ||
Multiple | 13 (7.7) | 6 (5.9) | 7 (10.4) | ||
Antihypertensive drugs | |||||
Administerd§ | 101 (60.1) | 54 (53.5) | 47 (70.1) | 4.68 | .031 |
Nicardipine (IV) | 78 (46.4) | 41 (40.6) | 37 (55.2) | 3.47 | .063 |
Labetalol (IV) | 37 (22.0) | 23 (22.8) | 14 (20.9) | 0.08 | .774 |
PO medication | 11 (6.5) | 2 (2.0) | 9 (13.4) | 8.63 | .003 |
Not administerd | 67 (39.9) | 47 (46.5) | 20 (29.9) | ||
Sedative drugs | |||||
Administerd§ | 41 (24.4) | 20 (19.8) | 21 (31.3) | 2.91 | .088 |
Midazolam (IV) | 7 (4.2) | 5 (5.0) | 2 (3.0) | - | .704† |
Lorazepam (IV) | 4 (2.4) | 1 (1.0) | 3 (4.5) | - | .303† |
Dexmedetomidine | 18 (10.7) | 9 (8.9) | 9 (13.4) | 0.86 | .353 |
Others | 25 (14.9) | 12 (11.9) | 13 (19.4) | 1.80 | .180 |
Not administerd | 127 (75.6) | 81 (80.2) | 46 (68.7) |
3. 뇌재관류 손상 발생에 대한 위험요인
Table 4.
4. 뇌재관류 손상 여부에 따른 임상결과
Table 5.
Outcomes | Total (N=168) | Non-Injury (n=101) | Injury (n=67) | χ2 or Z | p |
---|---|---|---|---|---|
|
|||||
n (%) or Median (IQR) | |||||
|
|||||
Hemorrhagic transformation | |||||
Yes | 61 (36.3) | 29 (28.7) | 32 (47.8) | 6.32 | .012 |
No | 107 (63.7) | 72 (71.3) | 35 (52.2) | ||
Parenchymal hematoma | |||||
Yes | 9 (5.4) | 6 (5.9) | 3 (4.5) | 0.17 | .680 |
No | 159 (94.6) | 95 (94.1) | 64 (95.5) | ||
Decompressive craniectomy | |||||
Yes | 5 (3.0) | 3 (3.0) | 2 (3.0) | - | 1.000† |
No | 163 (97.0) | 98 (97.0) | 65 (97.0) | ||
Length of stay at ICU (day) | 3 (2-5) | 3 (2-5) | 3 (3-5) | -2.08 | .038‡ |
Length of stay in hospital (day) | 9 (6-14) | 8 (6-13) | 10 (7-16) | -1.36 | .173‡ |
NIHSS at discharge (n=124) | 6 (2-13) | 4.5 (1-10) | 9.5 (4-15) | -3.14 | .002‡ |
mRS at discharge | 3 (2-5) | 3 (1.5-4) | 4 (3-5) | -2.93 | .003‡ |
Favorable outcome | |||||
mRS 0-2 | 56 (33.3) | 41 (40.6) | 15 (22.4) | 6.01 | .014 |
mRS >3 | 112 (66.7) | 60 (59.4) | 52 (77.6) |