摘要
目的探讨急性缺血性卒中(AIS)血管内取栓术后继发恶性脑水肿(MBE)患者行去骨瓣减压术(DC)后预后不良的相关危险因素。方法纳入2018年2月至2023年3月于丽水市中心医院重症医学科接受血管内取栓治疗后继发MBE并行DC的AIS患者, 共69例, 均为前循环大血管闭塞患者。根据出院时改良Rankin量表(mRS)评分分为预后良好组(0~3分)和预后不良组(4~6分)。回顾性比较两组患者取栓术前、术后及DC后的临床、实验室及影像学资料的差异, 将两组差异有统计学意义(P<0.05)的指标纳入多因素logistic回归模型中进行分析, 筛选影响患者预后不良的危险因素。结果 69例患者出院时预后不良组37例, 预后良好组32例。与预后良好组比较, 预后不良组患者的年龄大, 取栓术前体温低、动脉粥样硬化的占比高、CT血管造影(CTA)参数达峰时间延迟>6 s的脑组织体积大、缺血半暗带体积大;取栓术后CT显示环池受压分级Ⅰ级患者的占比高、中线移位大, 取栓术后至脑疝时间短;DC后, 血清超敏C反应蛋白、神经元特异性烯醇化酶、D-二聚体、血钠水平均增高, 昏迷、重度残疾的发生率高, 两组上述指标的差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果提示, 年龄增高(OR=1.140, 95%CI:1.036~1.255, P=0.007)、取栓术前缺血半暗带体积增大(OR=1.031, 95%CI:1.012~1.051, P=0.002)、取栓术后环池受压分级Ⅰ级(OR=16.392, 95%CI:2.222~120.956, P=0.006)、DC后血清超敏C反应蛋白升高(OR=1.031, 95%CI:1.010~1.053, P=0.003)是AIS取栓术后继发MME患者DC后预后不良的独立危险因素。结论 AIS取栓术后继发MME患者DC后不良预后与高龄、大体积缺血半暗带、严重环池受压及术后炎性反应密切相关。
Objective To investigate the risk factors associated with poor prognosis after decompressive craniectomy(DC)in patients with malignant brain edema(MBE)secondary to endovascular thrombectomy for acute ischemic stroke(AIS).Methods A total of 69 patients with acute ischemic stroke(AIS)who underwent decompressive craniectomy(DC)following malignant brain edema(MBE)after endovascular thrombectomy at Department Intensive care Medicine,Lishui Central Hospital between February 2018 and March 2023 were included.All patients had large vessel occlusion in the anterior circulation.Based on the modified Rankin Scale(mRS)scores at discharge,patients were divided into the favored outcome group(mRS:0-3)and unfavored outcome group(mRS:4-6).Baseline characteristics,clinical,laboratory test and imaging data before thrombectomy,after thrombectomy and after DC were retrospectively compared between the two groups.Variables with statistically significant differences(P<O.05)were included in a multivariate logistic regression model to identify independent risk factors for poor prognosis.Results Among the 69 patients,37 were in the unfavored group and 32 in the favored outcome group at discharge.Compared with the favored outcome group,the unfavored outcome group had older age,lower pre-thrombectomy body temperature,higher prevalence of atherosclerosis,larger volumes of brain tissue with time-to-peak>6 s on CT angiography(CTA),and larger ischemic penumbra volume.Post-thrombectomy CT showed a higher proportion of patients with grade 1 cisternal compression,greater midline shift,and shorter time from thrombectomy to cerebral herniation.After DC,the poor prognosis group had higher levels of serum high-sensitivity C-reactive protein,neuron-specific enolase,D-dimer,and sodium,as well as higher incidences of coma,severe disability.All these differences were statistically significant(all P<0.05).Multivariate logistic regression analysis revealed that advanced age(0R=1.140,95%CI:1.036-1.255,P=0.007),larger ischemic penumbra volume before thrombectomy(OR=1.031,95%CI:1.012-1.051,P=0.002),grade I cisternal compression after thrombectomy(0R=16.392,95%CI:2.222120.956,P=0.006),and elevated serum C-reactive protein after DC(OR=1.031,95%CI:1.010-1.053,P=0.003)were independent risk factors for p0or prognosis after DC in AIS patients with MBE secondary to thrombectomy.Conclusion Poor prognosis after DC in AIS patients with MBE secondary to thrombectomy is closely associated with advanced age,large ischemic penumbra,severe cisternal compression,and postoperative inflammatory response.
作者
孙建
康义豪
孙景萍
蔡学礼
罗鸣
田昕
Sun Jian;Kang Yihao;Sun Jingping;Cai Xueli;Luo Ming;Tian Xin(Department of Intensive Care Medicine,Lishui Central Hospital,the Fifth Hospital Affiliated to Wenzhou Medical University,Lishui 323000,China;Department of Neurology,Lishui Central Hospital,the Fifth Hospital Affiliated to Wenzhou Medical University,Lishui 323000,China;Department of Neurosurgery,Lishui Central Hospital,the Fifth Hospital Affiliated to Wenzhou Medical University,Lishui 323O00,China)
出处
《中华神经外科杂志》
北大核心
2025年第11期1112-1118,共7页
Chinese Journal of Neurosurgery
基金
2020年丽水市科技计划(2020SJZC052)。
关键词
卒中
脑缺血
脑膨出
减压颅骨切除术
预后
危险因素
血管内取栓术
Stroke
Brainischemia
Encephalocele
Decompressive craniectomy
Prognosis
Risk factors
Endovascular thrombectomy
