标准大骨瓣减压联合间接血运重建术治疗急性大面积脑梗死及其预后的影响因素分析  

Application of standard large bone flap decompression combined with indirect revascularization in the treatment of acute large area cerebral infarction and analysis of prognostic factor

作　　者：崔颖 梁立志 潘笛笛 程哲 束汉生[1] 胡元亮 CUI Ying;LIANG Lizhi;PAN Didi;CHENG Zhe;SHU Hansheng;HU Yuanliang(The Second Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第二附属医院,安徽蚌埠233000

出　　处：《中国实用神经疾病杂志》2022年第3期330-335,共6页Chinese Journal of Practical Nervous Diseases

基　　金：蚌埠医学院自然科学基金重点项目(编号:2020byzd190);2021年度安徽高校自然科学研究重点基金项目(编号:KJ2021A0786);蚌埠医学院2020年度研究生科研创新计划自然科学类项目(编号:Byycx20098)。

摘　　要：目的探讨标准大骨瓣减压联合间接血运重建治疗急性大面积脑梗死的应用及预后的影响因素分析。方法回顾性分析蚌埠医学院第二附属医院2018-01—2021-04收治的53例急性大面积脑梗死患者的一般资料,比较标准大骨瓣减压和标准大骨瓣减压联合间接血运重建两种手术方式对预后的影响。2018-01—2019-09患者行手术治疗者分为标准大骨瓣减压术组,2019-09以来分为标准大骨瓣减压联合间接血运重建术组,通过单因素Logistic回归与多因素回归分析方法比较基础疾病、入院时NIHSS评分、GCS评分、年龄、大脑中动脉或颈内动脉狭窄或闭塞、梗死面积大小、入院时是否静脉溶栓、术前是否脑疝、是否机械取栓等是否影响患者预后,并筛选出影响预后的相关因素。结果年龄、脑疝、糖尿病、低密度脂蛋白(LDL-C)、房颤相比较,差异有统计学意义(P<0.05);心房颤动、糖尿病、年龄是预后不佳的独立高危因素(P<0.05);标准大骨瓣减压联合间接血运重建与标准大骨瓣减压术治疗大面积脑梗患者预后比较,差异无统计学意义,但前者手术方式治疗后的生存率及有效率较后者明显增加。结论急性大面积脑梗死患者早期行标准大骨瓣减压联合间接血运重建术后治愈率及有效率明显,并积极治疗基础疾病及预防脑疝的发生可在一定程度可改善患者的总体预后。Objective To explore the application of standard large bone flap decompression combined with indirect revascularization in the treatment of acute massive cerebral infarction and analyze the influencing factors of prognosis.Methods The general data of 53 patients with acute massive cerebral infarction in our hospital from January 2018 to April 2021 were analyzed retrospectively.The effects of standard large bone flap decompression and standard large bone flap decompression combined with indirect revascularization on the prognosis were com pared.From January 2018 to September 2019,patients undergoing surgical treatment were divided into standard large bone flap decompression group and standard large bone flap decompression combined with indirect revascu larization group since September 2019.Univariate Logistic regression and multivariate regression were used to com pare whether basic diseases,NIHSS score at admission,GCS score,age,stenosis or occlusion of middle cerebral ar tery or internal carotid artery,infarct size,intravenous thrombolysis at admission,cerebral hernia before operation and mechanical thrombectomy affect the prognosis,and to screen out the relevant factors affecting the prognosis.Results Age,brain hernia,diabetes,low density lipoprotein and atrial fibrillation were significantly different(P<0.05).Diabetes,atrial fibrillation and age were independent risk factors for poor prognosis(P<0.05).There was no significant difference in the prognosis between standard large bone flap decompression combined with indirect revascularization and standard large bone flap decompression in the treatment of large-area cerebral infarction,but the survival rate and effective rate of the former were significantly higher than those of the latter.Conclusion Early standard large bone flap decompression combined with indirect revascularization in patients with acute massive cerebral infarction has obvious cure rate and effective rate.Active treatment and prevention of cerebral hernia can improve the overall prognosis of pa

关 键 词：急性大面积脑梗死 间接血运重建术 预后 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]