大面积脑梗死去骨瓣减压术后迟发性脑过度灌注综合征的危险因素分析  

Risk factors of delayed cerebral hyperperfusion syndrome following decompressive hemicraniectomy for massive cerebral infarction

作　　者：李甲[1] 沈罡[1] 朱光耀[1] 陈茂送[1] 王波定 Li Jia;Shen Gang;Zhu Guangyao;Chen Maosong;Wang Boding(Department of Neurosurgery,Ningbo Medical Center Lihuili Hospital,Ningbo 315040,China;Department of Neurosurgery,Hwa Mei Hospital,Universiy of Chinese Academy of Sciences,Ningbo 315010,China)

机构地区：[1]宁波市医疗中心李惠利医院神经外科,浙江宁波315040 [2]中国科学院大学宁波华美医院神经外科,浙江宁波315010

出　　处：《中华危重症医学杂志（电子版）》2022年第2期111-117,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省基础公益研究计划项目(LGF21H170002)。

摘　　要：目的:探讨大面积脑梗死(MCI)去骨瓣减压术(DHC)后迟发性脑过度灌注综合征(dCHS)的临床特征和危险因素。方法:回顾性分析宁波市医疗中心李惠利医院2016年6月至2020年9月收治的行DHC的44例MCI患者,根据CHS是否发生及发生时间将其分为dCHS组(10例)、急性脑过度灌注综合征(aCHS)组(14例)和无脑过度灌注综合征(CHS)组(20例)。比较三组患者的一般资料,并采用多因素Logistic回归对dCHS相关危险因素进行分析。结果:dCHS组、aCHS组和无CHS组患者大脑中动脉(MCA)闭塞、出血转化及出血转化再手术比较,差异均有统计学意义(χ^(2)=17.720、24.144、18.324,P均<0.05)。多因素Logistic回归分析结果显示,MCA闭塞延迟再通[比值比(OR)=16.750,95%置信区间(CI)(1.111,252.468),P=0.042]与出血转化[OR=10.206,95%CI(1.095,95.123),P=0.041]是dCHS发生的独立危险因素。结论:MCA闭塞延迟再通与出血转化是行DHC的MCI患者发生dCHS的独立危险因素。Objective:To investigate the clinical characteristics and risk factors of delayed cerebral hyperperfusion syndrome(dCHS)after decompressive hemicraniectomy(DHC)for massive cerebral infarction(MCI).Methods:A retrospective analysis of 44 patients with MCI who underwent DHC at Ningbo Medical Center Lihuili Hospital from June 2016 to September 2020 was performed.The patients were divided into three groups:dCHS group(n=10),acute cerebral hyperperfusion syndrome(aCHS)group(n=14)and non-CHS group(n=20),based on whether CHS occurred and when it occurred.The general data of the three groups were compared,and the risk factors related to dCHS were analyzed by multivariate Logistic regression.Results:There were significant differences in middle cerebral artery(MCA)occlusion,hemorrhagic transformation,and reoperation after hemorrhagic transformation among these three groups(χ^(2)=17.720,24.144,18.324,all P<0.05).The results of multivariate Logistic regression analysis showed that delayed recanalization after MCA occlusion[odds ratio(OR)=16.750,95%confidence interval(CI)(1.111,252.468),P=0.042]and hemorrhagic transformation[OR=10.206,95%CI(1.095,95.123),P=0.041]were independent risk factors for the occurrence of dCHS.Conclusion:Delayed recanalization after MCA occlusion and hemorrhagic transformation are independent risk factors for dCHS in patients with MCI undergoing DHC.

关 键 词：大面积脑梗死 去骨瓣减压术 迟发性脑过度灌注综合征 急性脑过度灌注综合征 无效再通 

分 类 号：R743.33[医药卫生—神经病学与精神病学]