作者：邓瑶，张艳玲，周慧，刘丽莎，李宗奇，唐兴江，郭晓燕

单位：

646000 四川省泸州市，西南医科大学附属医院神经内科；通信作者：郭晓燕，E-mail：gxy19800312@163.com

Units：

Department of Neurology，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China；Corresponding author：GUO Xiaoyan，E-mail：gxy19800312@163.com

关键词：

脑梗死；大面积脑梗死；疝，脑；预后；影响因素分析

Keywords：

Brain infarction；Massive cerebral infarction；Hernia，cerebral；Prognosis；Root cause analysis

CLC：

R 743.33

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.012

Funds：

摘要：

背景　多种因素与脑梗死患者死亡有关，但目前关于大面积脑梗死患者脑疝及其死亡影响因素的研究报道较少见。目的　探讨大面积脑梗死患者脑疝及预后的影响因素。方法　选取 2014—2018 年在西南医科大学附属医院神经内科住院治疗的大面积脑梗死患者 172 例，根据脑疝发生情况分为脑疝组（n=61）和非脑疝组（n=111）；随访期间失访 14 例，根据随访结果分为死亡组（n=106）和存活组（n=52）。比较脑疝组与非脑疝组、死亡组与存活组患者一般资料、实验室检查指标、神经功能；大面积脑梗死患者脑疝的影响因素分析采用多因素 Logistic 回归分析，大面积脑梗死患者预后的影响因素分析采用 Cox 比例风险回归模型。结果　（1）脑疝组与非脑疝组患者年龄，性别，高血压、糖尿病、心房颤动、冠心病、短暂性脑缺血发作（TIA）/ 脑梗死病史，吸烟史，饮酒史，体温，收缩压，舒张压，白细胞计数，中性粒细胞计数，总胆固醇，三酰甘油，空腹血糖，高敏肌钙蛋白T，N末端脑钠肽前体（NT-proBNP），格拉斯哥昏迷量表（GCS）评分，心功能不全、头痛、呕吐、双眼凝视、意识障碍、肺部感染、心肌梗死发生率，行溶栓治疗及取栓治疗者所占比例比较，差异无统计学意义（P>0.05）；脑疝组患者行去骨板减压术者所占比例、美国国立卫生研究院卒中量表（NIHSS）评分高于非脑疝组，且两组出血性转化发生情况比较，差异有统计学意义（P<0.05）。多因素 Logistic 回归分析结果显示，年龄、脑实质出血是大面积脑梗死患者脑疝的影响因素（P<0.05）。（2）死亡组与存活组患者年龄，性别，高血压、糖尿病、心房颤动、冠心病、TIA/ 脑梗死病史，吸烟史，饮酒史，体温，舒张压，总胆固醇，三酰甘油，心功能不全、头痛、呕吐、双眼凝视、意识障碍、肺部感染、心肌梗死发生率，出血性转化情况，行溶栓治疗及取栓治疗者所占比例比较，差异无统计学意义（P>0.05）；存活组患者收缩压、白细胞计数、中性粒细胞计数、空腹血糖、高敏肌钙蛋白 T、NT-proBNP、NIHSS 评分及脑疝发生率低于死亡组，行去骨瓣减压术者所占比例及 CGS 评分高于死亡组（P<0.05）。Cox 比例风险回归模型分析结果显示，心肌梗死、脑疝、去骨瓣减压术、NIHSS 评分是大面积脑梗死患者预后的影响因素（P<0.05）。结论　年龄小、脑实质出血是大面积脑梗死患者脑疝的影响因素，而心肌梗死、脑疝、去骨瓣减压术、NIHSS 评分是大面积脑梗死患者预后的影响因素。

Abstract：

Background　Multiple factors are associated with the death in patients with cerebral infarction，however，there are few researches about influencing factors of cerebral hernia and death in patients with massive cerebralinfarction so far. Objective　To investigate the influencing factors of cerebral hernia and prognosis in patients with massivecerebral infarction. Methods　From 2014 to 2018，a total of 172 inpatients with massive cerebral infarction were selected in theDepartment of Neurology，the Affiliated Hospital of Southwest Medical University，and they were divided into cerebral herniagroup （n=61）and non-cerebral hernia group（n=111）according to the incidence of cerebral hernia，into death group （n=106）and survival group（n=52） according to the follow-up results（14 patients lost to follow-up）. General information，laboratoryexamination results and neurological function were compared between cerebral hernia group and non-cerebral hernia group，as well as survival group and dead group；multivariate Logistic regression analysis was used to analyze the influencing factorsof cerebral hernia in patients with massive cerebral infarction，and Cox proportional hazards regression model was used toanalyze the influencing factors of prognosis in patients with massive cerebral infarction. Results　（1）There was no statisticallysignificant difference in age，gender，history of hypertension，diabetes，atrial fibrillation，coronary heart disease，TIA/cerebral infarction，drinking or smoking，body temperature，SBP，DBP，WBC，neutrophil count，TC，TG，FPG，hs-cTnT，NT-proBNP，GCS score，incidence of cardiac insufficiency，headache，vomiting，paralysis of gaze，disturbance ofconsciousness，pulmonary infection or myocardial infarction，proportion of patients underwent thrombolysis or embolectomybetween cerebral hernia group and non-cerebral hernia group（P>0.05）；proportions of patients underwent decompressivecraniectomy and NIHSS score in cerebral hernia group were statistically significantly higher than those in non-cerebral herniagroup，and hemorrhagic transformation status was statistically significantly different between the two groups（P<0.05）.Multivariate Logistic regression analysis results showed that，age and intraparenchymal hemorrhage were influencing factors ofcerebral hernia in patients with massive cerebral infarction（P<0.05）.（2）There was no statistically significant difference inage，gender，history of hypertension，diabetes，atrial fibrillation，coronary heart disease，TIA/cerebral infarction，smokingor drinking，body temperature，DBP，TC，TG，incidence of cardiac insufficiency，headache，vomiting，paralysis of gaze，disturbance of consciousness，pulmonary infection or myocardial infarction，hemorrhagic transformation status，proportion ofpatients underwent thrombolysis or embolectomy between death group and survival group（P>0.05）；SBP，WBC，neutrophilcount，FPG，hs-cTnT，NT-proBNP，NIHSS score and incidence of cerebral hernia in survival group were statisticallysignificantly lower than those in death group（P<0.05），while proportion of patients underwent decompressive craniectomy andGCS score in survival group were statistically significantly higher than those in death group（P<0.05）.Cox proportional hazardsregression model analysis results showed that，myocardial infarction，cerebral hernia，decompressive craniectomy and NIHSSscore were influencing factors of prognosis in patients with massive cerebral infarction（P<0.05）. Conclusion　Young in ageand intraparenchymal hemorrhage are influencing factors of cerebral hernia in patients with massive cerebral infarction，moreovermyocardial infarction，cerebral hernia，decompressive craniectomy and NIHSS score are the influencing factors of prognosis.

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