开颅术后脑梗死的临床病因分析

Clinical etiology of cerebral infarction occurred after craniotomy

目的 探讨常规开颅手术后与脑梗死相关的临床病因。方法 将1451例行常规开颅术的患者分为梗死组和非梗死组。分组依据:(1)术后CT检查与术前相比,出现新的梗死灶;(2)出现与病变部位不相关的、新的功能障碍,记录与之相关的因素。应用SPSS9.0版统计软件包进行统计学分析,多元分析采用logistic回归。结果 (1)按年龄因素分析,梗死率差异有显著性(P=0.020)。(2)按病变性质,梗死率差异有显著性(P=0.006)。其中动脉瘤(8.1％)高于胶质瘤(2.4％,P=0.003),也高于其他病变组(2.7％,P=0.004)。(3)按病变部位分析,鞍区病变的梗死率(6.0％)高于幕上病变(2.0%,P=0.001)。(4)按手术入路分析,各入路的梗死率之间差异有显著性意义(P=0.003)。(5)多元分析结果:病变性质、病变部位和手术入路均和术后脑梗死显著相关,P值和回归系数分别为:0.0440和-0.2756,0.0103和-0.3762,0.0088和0.2896。 结论 常规择期开颅术后,脑梗死并发症的发生率为3.38％,动脉瘤术后脑梗死率高,直径>4.0 cm的血供丰富的脑膜瘤,术后发生脑梗死的危险性高于其他肿瘤,手术入路和手术操作是开颅术后脑梗死的主要原因。

Objective To investigate the clinical etiology of cerebral infarction after a routine craniotomy. Methods 1 451 patients undergone routine craniotomies in Beijing Tiantan hospital from Jan 1, 1999 to Dec 31, 1999, were divided into infarction group and non-infarction group. The standards for group classification were: 1. The CT scan after craniotomy showed new low density area (infarction) in the nonsurgical area; 2. New neurological deficits occurred irrelevant to the diseased area. If any one of the above presented, the patient was grouped to the infarction group, the remains were the non-infarction group. All the possible related factors were recorded and statistically analyzed by SPSS (9. 0 edition) software. Results Among the 1 451 patients, the number of the infarction group and the non-infarction group was 49 and 1 402 respectively. Age, surgical approach and pathological character of the lesions were significantly related to infarction in univariate analysis, with the aneurysm group having the highest ratio of infarction. Parasellar lesions were more likely to develop infarction than other supratentorial lesions. In multivariate analysis, pathological character and location of the lesion, as well as the surgical approach were significantly associated with infarction. Conclusion The morbidity rate of cerebral infarction after a routine craniotomy was 3. 38% . The possibility of cerebral infarction was higher than that of other tumors if a meningioma was larger than 4. 0 cm and rich in blood supply. The surgical approach and the surgical manipulation were the main reasons of postoperative cerebral infarction.