影响去骨瓣减压术治疗大脑中动脉供血区恶性梗死患者预后的因素分析  

Analysis of Factors Affecting the Prognosis of Patients with Malignant Middle Cerebral Artery Infarction Treated by Decompressive Craniectomy

作　　者：陈森 聂文 叶林 刘娟 祁晓瑜 CHEN Sen;NIE Wen;YE Lin;LIU Juan;QI Xiaoyu(Department of Neurosurgery,Jiaozhou Hospital,Dongfang Hospital affiliated to Tongji University,Qingdao 266300,Shandong,China;Intensive Care Unit,Jiaozhou Hospital,Dongfang Hospital affiliated to Tongji University,Qingdao 266300,Shandong,China;Department of International Medical,Jiaozhou Hospital,Dongfang Hospital affiliated to Tongji University,Qingdao 266300,Shandong,China)

机构地区：[1]同济大学附属东方医院胶州医院神经外科,山东青岛266300 [2]同济大学附属东方医院胶州医院重症监护室,山东青岛266300 [3]同济大学附属东方医院胶州医院国际医学部,山东青岛266300

出　　处：《中外医疗》2024年第18期46-49,共4页China & Foreign Medical Treatment

摘　　要：目的探讨影响去骨瓣减压术治疗大脑中动脉供血区恶性梗死患者预后的相关因素。方法回顾性选取2022年2月—2023年4月同济大学附属东方医院胶州医院收治的64例大脑中动脉供血区恶性梗死患者的临床资料,根据预后情况分为两组,预后良好组31例和预后不良组33例,比较两组是否接受溶栓治疗、是否存在中线移位、是否存在瞳孔不等大、发病至手术时间以及发病时美国国立卫生研究院中风量表(Na-tional Institutes of Health Stroke Scale,NIHSS)评分情况,分析影响去骨瓣减压术治疗大脑中动脉供血区恶性梗死效果的相关独立危险因素。结果发病时存在中线移位(β=2.343,OR=1.710)、发病时存在瞳孔不等大(β=2.184,OR=1.832)以及发病至手术时间>5 h(β=1.859,OR=1.960)为影响去骨瓣减压术治疗大脑中动脉供血区恶性梗死预后不良的独立危险因素,发病时接受溶栓治疗(β=-2.349,OR=0.819)为影响去骨瓣减压术治疗大脑中动脉供血区恶性梗死预后良好的保护性因素。结论针对大脑中动脉供血区恶性梗死,发病时存在中线移位、瞳孔不等大及发病至手术时间>5 h者,实施去骨瓣减压术,患者预后不良较多,而及时进行溶栓治疗,则对改善患者预后有积极意义。Objective To explore the related factors of the prognosis with patients of decompressive craniectomy in the treatment of malignant infarction in the of the prognosis with patients middle cerebral artery territory.Methods The clinical data of 64 patients with malignant infarction in middle cerebral artery territory admitted to Department of Neu-rosurgery in Jiaozhou Hospital,Dongfang Hospital affiliated to Tongji University from February 2022 to April 2023 were retrospectively selected and divided into two groups according to prognosis,31 cases in good prognosis group and 33 cases in poor prognosis group.Whether the two groups received thrombolytic therapy,whether there was midline shift,whether there was pupil inequality,the time from onset to operation and the National Institutes of Health Stroke Scale(NIHSS)score at onset were compared,and the related and independent risk factors affecting the effect of de-compressive craniectomy on malignant infarction in the middle cerebral artery were analyzed.Results The existence of midline shift at onset(β=2.343,OR=1.710),unequal pupil size at onset(β=2.184,OR=1.832)and the time from onset to operation>5 hours(β=1.859,OR=1.960)was an independent risk factor for the poor prognosis of malignant infarc-tion in the middle cerebral artery supply area treated by decompressive craniectomy,and thrombolysis at onset was a protective factor for the good prognosis of malignant infarction in the middle cerebral artery supply area treated by de-compressive craniectomy(β=-2.349,OR=0.819).Conclusion For malignant infarcts in the middle cerebral artery sup-ply area with midline displacement,dilated pupils and time>5 h from onset to operation,decompressive craniotomy has more adverse prognosis,and timely thrombolytic therapy can improve the prognosis of patients.

关 键 词：去骨瓣减压术 大脑中动脉供血区 恶性梗死 危险因素 保护性因素 

分 类 号：R651.1[医药卫生—外科学]