术前全身炎症反应指数对大脑中动脉栓塞大面积脑梗死行去骨瓣减压术预后价值的研究  

Prognostic value of pre-operation systemic inflammation response index in decompressive craniectomy for massive cerebral infarction caused by middle cerebral artery embolization

作　　者：黄宝辰 李蕾[2] 张爱文[3] 孙健[2] 樊明超[2] 张欣[4] Huang Baochen;Li Lei;Zhang Aiwen;Sun Jian;Fan Mingchao;Zhang Xin(Department of Neurosurgery,Rizhao People's Hospital,Rizhao 276827,China;Department of Neurosurgical Intensive Care Unit,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of Sterilization and Supply Center,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of Neurosurgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]山东省日照市人民医院神经外科,日照276826 [2]青岛大学附属医院神经外科监护室,青岛266003 [3]青岛大学附属医院消毒供应中心,青岛266003 [4]青岛大学附属医院神经外科,青岛266003

出　　处：《中国综合临床》2022年第5期441-447,共7页Clinical Medicine of China

摘　　要：目的探讨全身炎症反应指数(systemic inflammation response index, SIRI)与大面积脑梗死(massive cerebral infarction, MCI)患者开颅去骨瓣减压术后临床转归的相关性。方法回顾性分析2016年1月至2020年12月就诊于青岛大学附属医院并接受开颅去骨瓣减压术的50例MCI患者临床资料。呈正态分布的计量资料以xˉ±s表示, 非正态分布的计量资料以M(Q, Q), 两组间比较采用t检验或秩和检验, 多因素Logistic回归分析SIRI与MCI患者预后之间的关系, 建立预测模型。通过受试者工作特征曲线(receiver operating characteristic curve, ROC)分析SIRI预测价值和最佳截止值。结果 50例开颅去骨瓣减压术的MCI患者, 预后良好组12例(24%, 12/50);预后不良组38例(76%, 12/50), 其中住院期间死亡9例(18%, 9/50)。预后良好组和预后不良组患者年龄[(54±11)岁与(63±9)岁, t=2.72, P=0.015]、体质量指数(body mass index, BMI):[(23.91±2.64)kg/m^(2)与(26.72±3.28)kg/m^(2), t=3.01, P=0.006)]、中性粒细胞计数[7.08(5.12, 7.38)×10^(9)/L与10.59(8.91, 14.64)×10^(9)/L, Z=5.72, P<0.001)、白细胞计数[(9.09±2.80)×10^(9)/L与(13.20±3.49)×10^(9)/L, t=4.16, P<0.001]、SIRI[2.49(1.78, 4.75)与8.34(5.17, 13.61), Z=3.84, P<0.001)、哥拉斯哥昏迷评分[12(9, 14)与8(6, 10), Z=3.36, P=0.002)和淋巴细胞计数[1.58(0.91, 1.91)×10^(9)/L与0.77(0.59, 1.02)×10^(9)/L, Z=3.30, P=0.001), 两组比较差异均有统计学意义。优势半球梗死患者预后较非优势半球梗死患者差[22例(91.67%, 22/24)与16例(61.54%, 16/26), χ^(2)=6.21, P=0.013]。预后良好组ICU住院时间显著短于预后不良组[2(1, 5)d与8(3, 19)d, Z=2.78, P=0.005]。多因素Logistic回归分析显示SIRI及哥拉斯哥昏迷评分与患者临床预后相关(SIRI:OR:2.378, 95%CI:1.131~5.003, P=0.022;入院哥拉斯哥昏迷评分:OR:0.548, 95%CI:0.307~0.980, P=0.043)。SIRI预测不良预后的ROC曲线分析:曲线下面积(area under the curve, AUC):0.871(95%CI:0.765~0.976, P<0.001), Objective To explore the correlation between systemic inflammatory response index(SIRI)and clinical outcome of patients with massive cerebral infarction(MCI)after craniotomy and decompression.Methods The clinical data of 50 MCI patients who were treated in the Affiliated Hospital of Qingdao University from January 2016 to December 2020 and underwent craniotomy and decompression were retrospectively analyzed.The measurement data of normal distribution were expressed as x¯±s,and the measurement data of non normal distribution were expressed as M(Q1,Q3).T-test or rank sum test was used for comparison between the two groups.Multivariate Logistic regression was used to analyze the relationship between SIRI and prognosis of MCI patients and establish a prediction model.The predictive value and optimal cutoff value of SIRI were analyzed by receiver operating characteristic curve(ROC).Results Among the 50 MCI patients who underwent craniotomy and decompression,12(24%,12/50)had a good prognosis;In the poor prognosis group,38 cases(76%,12/50),of which 9 cases(18%,9/50)died during hospitalization.The age of patients in the good prognosis group and the poor prognosis group((54±11)years and(63±9)years;t=2.72,P=0.015),body mass index(BMI):((23.91±2.64)kg/m^(2) and(26.72±3.28)kg/m^(2),t=3.01,P=0.006)),neutrophil count(7.08(5.12,7.38))×10^(9)/L and 10.59(8.91,14.64)×10^(9)/L,Z=5.72,P<0.001),white blood cell count((9.09±2.80)×10^(9)/L and(13.20±3.49)×10^(9)/L;t=4.16,P<0.001),SIRI(2.49(1.78,4.75)and 8.34(5.17,13.61);Z=3.84,P<0.001),Glasgow Coma Score(12(9,14)and 8(6,10);Z=3.36,P=0.002)and lymphocyte count(1.58(0.91,1.91)×10^(9)/L and 0.77(0.59,1.02)×10^(9)/L;Z=3.30,P=0.001).The difference between the two groups was statistically significant.The prognosis of patients with dominant hemisphere infarction was worse than that of patients with non-dominant hemisphere infarction(22 cases(91.67%,22/24)vs.16 cases(61.54%,16/26);χ^(2)=6.21,P=0.013).The ICU stay in the good prognosis group was significantly shorter than that i

关 键 词：脑梗死 开颅去骨瓣减压术 全身炎症反应指数 预后 

分 类 号：R651.12[医药卫生—外科学]