大面积脑梗死病人去骨瓣减压术治疗早期预后的影响因素分析

Prognostic factors of patients with massive cerebral infarction undergoing decompressive craniectomy

目的 探讨去骨瓣减压术治疗的大面积脑梗塞出院时预后的影响因素。方法 回顾性分析2014~2021年去骨瓣减压术治疗的80例大面积脑梗塞的临床资料。出院时,采用GOS评分评估预后,其中4~5分为预后良好,1~3分为预后不良。结果出院时,预后良好48例,预后不良32例。单因素分析显示脑梗塞部位、术前活化部分凝血活酶时间(APTT)、中线移位程度、术前瞳孔对光反射与出院时预后有关(P<0.05),多因素logistic回归分析显示,术前APTT延长(OR=1.994;95%CI 1.406~2.828;P<0.001)、中线移位≥10 mm(OR=5.793;95%CI 1.024~32.784;P=0.047)、术前瞳孔对光反射消失(OR=7.835;95%CI 1.744~35.195;P=0.007)是大面积脑梗塞去骨瓣减压术后预后不良的独立危险因素。结论 去骨瓣减压术治疗的大面积脑梗塞出院时预后与术前中线移位、瞳孔改变及APTT等因素相关。

Objective To investigate the prognostic factors of patients with massive cerebral infarction treated by decompressive craniectomy.Methods The clinical data of 80 patients with massive cerebral infarction treated by decompressive craniectomy from 2014 to 2021 were retrospectively analyzed.On discharge,GOS score was used to evaluate the prognosis,with a GOS score of 4~5 as a good prognosis and a score of 1~3 as a poor prognosis.Results On discharge,48 patients had good prognoses and 32 patients had poor prognoses.Univariate analysis showed that location of cerebral infarction,preoperative activated partial thromboplastin time(APTT),midline shift and preoperative pupillary light reflex were correlated with the prognoses of patients with massive cerebral infarction(P<0.05).Multivariate logistic regression analysis showed that prolonged preoperative APTT(OR=1.994;95%CI 1.406~2.828;P<0.001),midline shift≥10 mm(OR=5.793;95%CI 1.024~32.784;P=0.047),disappearance of pupillary light reflex before operation(OR=7.835;95%CI 1.744~35.195;P=0.007)were independent risk factors for poor prognoses of patients with massive cerebral infarction after decompressive craniectomy.Conclusions The prognoses of patients with massive cerebral infarction treated by decompressive craniectomy is related to midline shift,pupillary light reflex and APTT.