摘要
目的探讨颅脑外伤并发小脑幕裂孔疝患者继发枕叶梗死的危险因素。方法回顾性纳入2015年1月至2018年6月期间厦门大学附属东南医院神经外科收治的颅脑损伤后急性小脑幕裂孔疝患者。对枕叶梗死组与非枕叶梗死组患者的人口统计学、临床资料以及影像学特征进行比较。采用多变量logistic回归分析确定继发枕叶梗死的独立危险因素。结果共纳入150例小脑幕裂孔疝患者,男性127例(84.7%),女性23例(15.3%);中位年龄37岁(四分位数间距19~55岁,范围7~84岁);基线格拉斯哥昏迷量表评分(7.41±0.16)分。34例(22.7%)患者术后继发枕叶梗死。枕叶梗死组术前休克、术前格拉斯哥昏迷量表评分、术前瞳孔情况、脑疝持续时间、环池显影程度、中线偏移程度、血肿类型以及大脑后动脉P2段移位程度与非枕叶梗死组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,大脑后动脉P2段移位程度[优势比(odds ratio,OR)1.665,95%可信区间(confidence interval,CI)1.336~2.076;P<0.001]、术前休克(OR 53.191,95%CI 6.724~420.748;P<0.001)以及环池显影程度(OR 32.108,95%CI 5.155~200.00;P<0.001)为急性小脑幕裂孔疝患者发生枕叶梗死的独立危险因素。结论大脑后动脉P2段移位程度、术前休克和环池显影程度是颅脑外伤并发小脑幕裂孔疝患者继发枕叶梗死的独立危险因素。大脑后动脉P2段以远血管在脑疝后被延展牵拉形成的急性机械性痉挛和血管内皮损伤可能是继发枕叶梗死的重要病理生理学基础,术前休克导致的全脑缺氧内环境对后期枕叶梗死形成的作用也不容忽视,而环池显影程度则可能是术后枕叶梗死形成的良好临床预警指标。
Objective To investigate the risk factors for secondary occipital lobe infarction in patients with craniocerebral trauma complicated with transtentorial herniation.Methods Patients with acute transtentorial herniation after craniocerebral trauma admitted to the Department of Neurosurgery,the Affiliated Southeast Hospital of Xiamen University from January 2015 to June 2018 were enrolled retrospectively.The demographics,clinical and imaging characteristics in occipital lobe infarction group and non-occipital lobe infarction group were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for secondary occipital lobe infarction.Results A total of 150 patients with transtentorial herniation were included in the study,including 127 males(84.7%)and 23 females(15.3%).Median age was 37 years(interquartile range19-55 years;range7-84 years).The baseline Glasgow Coma Scale score was 7.41±0.16.Thirty-four patients(22.7%)had secondary occipital lobe infarction after procedure.There were significant differences in preoperative shock,preoperative Glasgow Coma Scale score,preoperative pupil condition,duration of cerebral hernia,degree of cisterna ambiens development,degree of midline shift,hematoma type and degree of posterior cerebral artery P2 segment shift between the occipital lobe infarction group and the non-occipital lobe infarction group(all P<0.05).Multivariate logistic regression analysis showed that the degree of posterior cerebral artery P2 segment shift(odds ratio[OR]1.665,95% confidence interval[CI]1.336-2.076;P<0.001),preoperative shock(OR 53.191,95%CI 6.724-420.748;P<0.001)and degree of cisterna ambiens development(OR 32.108,95%CI 5.155-200.00;P<0.001)were the independent risk factors for patients with acute transtentorial herniation.Conclusions The degree of posterior cerebral artery P2 segment shift,preoperative shock and degree of cisterna ambiens development were the independent risk factors for secondary occipital lobe infarction in patients with craniocerebral trauma complicated with transtentorial herniation.The acute mechanical spasm and vascular endothelial injury formed by the distal vessels beyond the P2 segment of the posterior cerebral artery after cerebral hernia may be an important pathophysiological basis for secondary occipital lobe infarction.The role of hypoxic internal environment caused by preoperative shock in the formation of late occipital lobe infarction cannot be ignored,and the degree of cisterna ambiens may be a good clinical warning indicator for postoperative occipital lobe infarction.
作者
黄巍
王文浩
李君
邹小君
罗飞
张源
张明升
简腾景
汤志辉
Huang Wei;Wang Wenhao;Li Jun;Zou Xiaojun;Luo Fei;Zhang Yuan;Zhang Mingsheng;Jian Tengjing;Tang Zhihui(Department of Neurosurgery,the 909th Hospital of PLA Joint Logistics Support Force,the Affiliated Southeast Hospital of Xiamen University,Zhangzhou 363000,China)
出处
《国际脑血管病杂志》
2020年第12期910-915,共6页
International Journal of Cerebrovascular Diseases
基金
福建省自然科学基金(2018J01152)。
关键词
脑梗死
枕叶
脑疝
脑损伤
创伤性
危险因素
Cerebral infarction
Occipital lobe
Encephalocele
Brain injuries,traumatic
Risk factors
