摘要
目的探讨无创脑水肿动态监测技术在介入治疗的急性颅内前循环大血管闭塞患者中的临床应用价值。方法2022年3月至2023年3月前瞻性收治60例急性颅内前循环大血管闭塞患者,按随机数字表法随机分为观察组(n=30)和对照组(n=30)。观察组介入术后采用无创脑水肿动态监测指导治疗;对照组介入术后采用常规经验性治疗。结果与对照组相比,观察组出院3个月预后良好率(mRS评分0~2分)明显增高(40.0%vs.26.7%,P=0.035),甘露醇日均用量明显降低[(292.5±94.6)mL vs.(352.6±112.4)mL,P=0.029],甘露醇使用时间明显缩短[(12.1±5.2)d vs.(15.2±6.1)d,P=0.038],肾功能损害发生率明显降低(6.7%vs.26.7%,P=0.038)。无创脑水肿动态监测结果显示,观察组患者发病3 d电磁扰动系数达峰值,之后缓慢下降;甘露醇治疗后,电磁扰动系数明显下降,治疗1 h下降最显著,治疗3 h渐趋平稳。观察组30例患者中,17例(56.7%)介入术后实施去骨瓣减压术,13例(43.3%)未实施去骨瓣减压术。与未实施去骨瓣减压术患者相比,实施去骨瓣减压术患者电磁扰动系数明显降低[(116.3±8.7)vs.(127.1±14.1),P=0.016]。ROC曲线分析显示,电磁扰动系数对急性前循环大血管闭塞患者介入术后实施去骨瓣减压术具有一定的预测价值,曲线下面积为0.756(95%CI 0.565~0.893,P=0.005),最佳截断值为112.5,敏感度、特异度和约登指数分别为52.9%、92.3%和0.453。结论对于介入治疗的急性颅内前循环大血管闭塞患者,无创脑水肿动态监测技术可以指导甘露醇的使用、减少并发症及改善患者预后。
Objective To explore the clinical application value of noninvasive dynamic brain edema monitoring technology in patients with acute anterior circulation large vessel occlusion undergoing interventional therapy.Methods From March 2022 to March 2023,60 patients with acute anterior circulation large vessel occlusion were prospectively enrolled and randomly divided into an observation group(n=30)and a control group(n=30)using a random number table.After interventional therapy,the observation group received treatment guided by noninvasive dynamic brain edema monitoring,while the control group received conventional empirical treatment.Results Compared with the control group,the observation group showed a significantly higher rate of favorable prognosis(modified Rankin Scale score 0~2)at 3 months after discharge(40.0%vs.26.7%,P=0.035),a significantly lower mean daily dosage of mannitol[(292.5±94.6)mL vs.(352.6±112.4)mL,P=0.029],a significantly shorter duration of mannitol use[(12.1±5.2)days vs.(15.2±6.1)days,P=0.038],and a significantly lower incidence of renal impairment(6.7%vs.26.7%,P=0.038).The noninvasive dynamic brain edema monitoring results indicated that in the observation group,the electromagnetic disturbance coefficient peaked at 3 days after onset and then gradually declined.After mannitol treatment,the electromagnetic disturbance coefficient decreased significantly,with the most pronounced decrease at 1 hour post-treatment,gradually stabilizing by 3 hours post-treatment.Among the 30 patients in the observation group,17(56.7%)underwent decompressive craniectomy after interventional therapy,while 13(43.3%)did not.Compared to patients who did not undergo decompressive craniectomy,those who did showed a significantly lower electromagnetic disturbance coefficient[(116.3±8.7)vs.(127.1±14.1),P=0.016].ROC curve analysis revealed that the electromagnetic disturbance coefficient had certain predictive value for the need of decompressive craniectomy after interventional therapy in patients with acute anterior circulation large vessel occlusion.The area under the curve was 0.756(95%CI 0.565-0.893,P=0.005),with an optimal cut-off value of 112.5.The sensitivity,specificity,and Youden index were 52.9%,92.3%,and 0.453,respectively.Conclusion For patients with acute intracranial anterior circulation large vessel occlusion undergoing interventional therapy,noninvasive dynamic brain edema monitoring technology can guide the use of mannitol,reduce complications,and improve patient prognosis.
作者
朱金钊
张建刚
杨新丽
吴坤
冯光
ZHU Jinzhao;ZHANG Jiangang;YANG Xinli;WU Kun;FENG Guang(Neuro-Intensive Care Unit,Department of Neurology,Anyang People's Hospital,Anyang,Henan 455000,China;Neuro-Intensive Care Unit,Department of Neurosurgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)
出处
《中国临床神经外科杂志》
2025年第10期596-600,共5页
Chinese Journal of Clinical Neurosurgery
关键词
急性缺血性脑卒中
颅内前循环大血管闭塞
介入治疗
无创脑水肿动态监测技术
acute ischemic stroke
anterior circulation large vessel occlusion
interventional therapy
noninvasive dynamic brain edema monitoring
