老年小脑梗死患者颅后窝减压术后出血转化的影响因素分析  

Analysis of influencing factors of hemorrhagic transformation after decompression of posterior cranial fossa in elderly patients with cerebellar infarction

作　　者：王猛 张永光 高艺博 WANG Meng;ZHANG Yongguang;GAO Yibo(Zhoukou Hospital of Traditional Chinese Medicine,Zhoukou 466000,China)

机构地区：[1]周口市中医院,河南周口466000

出　　处：《中国实用神经疾病杂志》2020年第21期1906-1911,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省中医药科学研究专项课题(编号:2016ZY3047)。

摘　　要：目的分析老年小脑梗死患者经颅后窝减压术治疗后发生出血转化的影响因素,为术后出血转化的预防提供指导,以改善患者预后。方法回顾分析2015-01—2020-01周口市中医院老年小脑梗死患者的临床资料,从中筛选符合条件的60例患者为研究对象。颅后窝减压术后48 h内定时复查头颅CT,统计出血转化发生情况及患者基线资料,包括性别、年龄、格拉斯哥昏迷量表(GCS)评分、梗死灶直径、术前溶栓情况及有无高血压、糖尿病、高脂血症、冠心病、房颤史;统计术前患者的血清纤维蛋白原(FIB)、同型半胱氨酸(Hcy)、基质金属蛋白酶9(MMP-9)、胶质纤维酸性蛋白(GFAP)水平,经单因素与多因素分析老年小脑梗死患者颅后窝减压术后出血转化的影响因素。结果60例老年小脑梗死患者经颅后窝减压术治疗后14例发生出血转化,发生率23.33%;将全部可能的影响因素纳入,经单因素与多因素分析,结果显示梗死灶直径≥5 cm、房颤史与术前血清MMP-9、GFAP高表达是老年小脑梗死患者颅后窝减压术后出血转化的影响因素(OR>1,P<0.05)。结论梗死灶直径≥5 cm、有房颤史、术前血清MMP-9、GFAP高表达均可导致老年小脑梗死患者颅后窝减压术后出血转化风险升高,临床可据此进行合理的术前干预,以降低患者术后出血转化风险,可能对改善患者预后有积极意义。Objective To analyze the influencing factors of hemorrhagic transformation in elderly patients with cerebellar infarction after posterior cranial fossa decompression,and to provide guidance for the prevention of postoperative hemorrhagic transformation in the future,to improve the patient’s prognosis.Methods The clinical data of elderly cerebellar infarction patients who were treated from January 2015 to January 2020 in our hospital were retrospectively analyzed,and 60 eligible patients were selected as the research objects.The cranial CT was regularly reviewed within 48 hours after decompression of the posterior cranial fossa,and the occurrence of hemorrhagic transformation and the patient's baseline data were counted,including gender,age,Glasgow Coma Scale(GCS)score,infarct diameter,preoperative thrombolysis and whether there was history of hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation;Counted serum fibrinogen(FIB),homocysteine(Hcy),matrix metalloproteinase 9(MMP-9)and glial fibrillary acidic protein(GFAP)levels in preoperative patients,univariate and multivariate analysis were used to examine the influencing factors of hemorrhage conversion after decompressive posterior cranial fossa in elderly patients with cerebellar infarction.Results In 60 elderly patients with cerebellar infarction,14 patients underwent hemorrhage conversion after posterior cranial fossa decompression,and the incidence rate was 23.33%.All possible influencing factors were included.The results of single factor and multifactor analysis showed that the infarct diameter 5cm,history of atrial fibrillation and high expression of preoperative serum MMP-9 and GFAP were the influencing factors of hemorrhagic transformation after decompression of posterior cranial fossa in elderly patients with cerebellar infarction(OR>1,P<0.05).Conclusion Infarct diameter≥5cm,history of atrial fibrillation,preoperative serum MMP-9,GFAP high expression can all lead to increased risk of hemorrhagic transformation after decompres

关 键 词：小脑梗死 颅后窝减压术 出血转化 影响因素 老年 

分 类 号：R743.33[医药卫生—神经病学与精神病学]