重型颅脑损伤患者标准大骨瓣减压术后脑梗死发生危险因素分析  

Analysis of Risk Factors of Cerebral Infarction in Patients with Severe Craniocerebral Injury after Standard Large Bone Flap Decompression

作　　者：孟发财[1] 郭宝瑞 李英 MENG Facai;GUO Baorui;LI Ying(Department of Neurosurgery,Shaanxi Provincial People's Hospital,Xi'an 710065,China;Department of Clinical Laboratory,Shaanxi Rehabilitation Hospital,Xi'an 710065,China)

机构地区：[1]陕西省人民医院神经外科,西安710065 [2]陕西省康复医院检验科,西安710065

出　　处：《临床误诊误治》2024年第20期36-40,共5页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省自然科学基础研究计划项目(2024JC-YBQN-0952)。

摘　　要：目的 探讨重型颅脑损伤患者标准大骨瓣减压术后脑梗死发生危险因素,以便早期诊断术后脑梗死、防范术后误诊误治的发生。方法 纳入2020年1月至2022年12月收治的135例实施标准大骨瓣减压术的重型颅脑损伤患者,依据术后是否发生脑梗死将患者分为发生组与未发生组,比较2组一般资料及实验室指标,并分析重型颅脑损伤患者标准大骨瓣减压术后脑梗死发生的危险因素。结果 135例重型颅脑损伤患者标准大骨瓣减压术后共有37例发生脑梗死,发生率为27.41%。发生组脑疝、蛛网膜下腔出血占比及半胱氨酸蛋白酶-1(Caspase-1)、白细胞介素-18(IL-18)、白细胞介素-37(IL-37)水平高于未发生组,入院时格拉斯哥昏迷指数评分(GCS)低于未发生组(P<0.01);多因素Logistic回归分析结果显示,入院时GCS评分高是重型颅脑损伤患者标准大骨瓣减压术后脑梗死发生的保护因素(P<0.05);Caspase-1、IL-18、IL-37水平高是重型颅脑损伤患者标准大骨瓣减压术后脑梗死发生的危险因素(P<0.05,P<0.01)。结论 重型颅脑损伤患者标准大骨瓣减压术后脑梗死发生风险较高,入院时GCS评分低及Caspase-1、IL-18、IL-37水平高可能会增加患者术后脑梗死的发生风险。通过对患者GCS评分、Caspase-1、IL-18、IL-37进行监测,可早期诊断术后脑梗死,防范术后误诊误治的发生。Objective To investigate the risk factors of cerebral infarction in patients with severe craniocerebral injury(SCCI)after standard large bone flap decompression,and in order to diagnose postoperative cerebral infarction early and prevent misdiagnosis and mistreatment after surgery.Methods A total of 135 patients with SCCI who underwent standard large bone flap decompression from January 2020 to December 2022 were included in the study.According to occurrence of cerebral infarction after surgery,the patients were divided into the occurrence group and the non-occurrence group.The general data and laboratory indicators of the two groups were compared,and the risk factors of cerebral infarction in SCCI patients after standard large bone flap decompression were analyzed.Results A total of 37(27.41%)patients of 135 patients with SCCI had cerebral infarction after standard large bone flap decompression.The proportion of cerebral hernia,subarachnoid hemorrhage and the levels of Caspase-1,interleukin-18(IL-18)and interleukin-37(IL-37)in occurrence group were higher than those in non-occurrence group,and the Glasgow Coma Index(GCS)score at admission was lower than that in non-occurrence group(P<0.01).Multivariate Logistic regression analysis showed that high GCS score at admission was a protective factor for cerebral infarction after standard large bone flap decompression in SCCI patients(P<0.05).High levels of Caspase-1,IL-18 and IL-37 were risk factors for cerebral infarction in patients with SCCI after standard large bone flap decompression(P<0.05,P<0.01).Conclusion Patients with SCCI have a higher risk of cerebral infarction after standard large bone flap decompression.Low GCS score and high levels of Caspase-1,IL-18 and IL-37 at admission may increase the risk of cerebral infarction.Monitoring the patient's GCS score,Caspase-1,IL-18,and IL-37 can help early diagnosis of postoperative cerebral infarction,so as to prevent misdiagnosis and mistreatment after surgery.

关 键 词：重型颅脑损伤 标准大骨瓣减压术 脑梗死 危险因素 格拉斯哥昏迷指数评分 半胱氨酸蛋白酶-1 白细胞介素-18 白细胞介素-37 

分 类 号：R651.15[医药卫生—外科学]