摘要
目的:探究颅内压(ICP)相关参数在大面积脑梗死去骨瓣减压术(DC)后的临床应用价值。方法:2018年6月至2023年6月河南省人民医院神经外科收治的186例大面积脑梗死接受DC的患者,随机数字法分组分为ICP组(93例)及对照组(93例),ICP组在DC手术时置入颅内压探头5~7 d,监测并记录ICP值及ICP波幅与ICP的相关系数(RAP)、压力相关指数(PRx),比较两组的临床资料差异,分析不良事件发生情况,用Kaplan-Meier方法进行生存分析,观察30 d生存情况。术后6个月根据改良Rankin量表评估,把ICP组分为预后良好组(0~4级,55例)和预后不良组(5~6级,38例),采用单因素分析比较两组临床资料和ICP、RAP、PRx的差异,多因素Logistic回归法分析评估影响患者预后的独立不良因素。采用受试者工作特征(ROC)曲线分析ICP相关参数评价预后的预测价值。结果:ICP组与对照组比较,ICP组患者ICU住院时长、肺部感染发生率、电解质紊乱发生率低于对照组(14.37±2.83、53.8%、16.1%比17.59±3.04、78.5%、30.1%,t=1.362,χ^(2)=0.614、1.023,P<0.05),术后脑出血、术后脑梗死、颅内感染发生率与对照组比(11.8%、9.7%、9.7%比9.7%、8.6%、10.8%,χ^(2)=2.309、1.453、2.367,P>0.05)。Kaplan-Meier方法生存分析显示ICP组30 d生存率高于对照组(81.7%比71.0%,χ^(2)=3.980,P<0.05)。预后良好组的ICP、RAP、PRx均低于预后不良组[(11.9±2.4、0.31±0.12、0.18±0.16)比(17.8±2.2、0.46±0.17、0.29±0.17),t=-1.547、0.105、0.355,P<0.05]。多因素Logistic回归显示ICP、RAP、PRx是影响预后的独立不良因素,ICP、RAP、PRx的偏回归系数分别为0.946、1.037、1.102,Wald值分别为6.372、1.207、1.326,95%可信区间(CI)分别为1.017~7.051、1.113~9.974、1.106~11.538[比值比(OR)=0.068、1.207、1.326,P<0.05]。ICP、RAP、PRx对大面积脑梗死DC后预后有预测价值,三者的预测作用一致,曲线下面积为0.902(95%CI:0.841~0.963)、0.802(95%CI:0.715~0.889)、0.933(95%CI:0.871~0.99
Objective To explore the clinical application value of intracranial pressure(ICP)related parameters in patients with massive supratentorial cerebral infarction after decompressive craniectomy(DC).Methods From June 2018 to June 2023,186 patients with large-area cerebral infarction who underwent DC in Department of Neurosurgery of Henan Provincial People’s Hospital were randomly divided into an ICP group(93 cases)and a control group(93 cases)using a random number method.During DC surgery,intracranial pressure probes were placed in the ICP group for 5-7 days,and ICP values,the correlation coefficient(RAP)between ICP amplitude and ICP,and the pressure related index(PRx)were monitored and recorded.The clinical data differences between the two groups were compared,and the occurrence of adverse events was analyzed.The Kaplan-Meier method was used for survival analysis,and the 30-day survival was observed.At 6th month after surgery,the ICP group was divided into a good prognosis subgroup(0-4 grades,55 cases)and a poor prognosis subgroup(5-6 grades,38 cases)based on the improved Rankin scale evaluation.Univariate analysis was used to compare the clinical data and differences in ICP,RAP,and PRx between the two groups.Multivariate logistic regression was used to analyze the independent adverse factors affecting the prognosis of patients.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of ICP related parameters for prognosis.Results Compared with the control group,the length of ICU stay,incidence of pulmonary infection and incidence of electrolyte disturbance in the ICP group were lower than those in the control group(14.37±2.83,53.8%,16.1%vs.17.59±3.04,78.5%,30.1%,t=1.362,χ^(2)=0.614,1.023,P<0.05),the incidence of postoperative cerebral hemorrhage,postoperative cerebral infarction and intracranial infection was higher than that of the control group(11.8%,9.7%,9.7%vs.9.7%,8.6%,10.8%).Kaplan-Meier survival analysis showed that the 30 day survival rate in ICP group was higher than
作者
张明
葛继晖
韩冰
王炬
任志强
梅雷凯
韩冰莎
栗艳茹
李娇
陈勇
冯光
Zhang Ming;Ge Jihui;Han Bing;Wang Ju;Ren Zhiqiang;Mei Leikai;Han Bingsha;Li Yanru;Li Jiao;Chen Yong;Feng Guang(Department of Neurosurgery,Henan Provincial People’s Hospital(People’s Hospital of Zhengzhou University),Zhengzhou 450003,China;Department of Neurology,Fifth Clinical Medical School,Henan University of Traditional Chinese Medicine(Zhengzhou People’s Hospital),Zhengzhou 450003,China;Department of Neurosurgery,Zhengzhou First People’s Hospital,Zhengzhou 450004,China)
出处
《中华实验外科杂志》
CAS
2024年第5期1058-1063,共6页
Chinese Journal of Experimental Surgery
基金
河南省医学科技攻关计划省部共建重点项目(SBGJ202002001)
河南省医学科技攻关项目(LHGJ20220786)
河南省医学科技攻关项目(LHGJ20200703)。
关键词
脑梗死
去骨瓣减压术
颅内压
Cerebral infarction
Decompression surgery with bone flap removal
Intracranial pressure
