术前梗死脑组织/全脑体积比值与脑梗死患者去骨瓣减压术后预后的关系

doi:10.19854/j.cnki.1008-2425.2022.06.0005

摘要/Abstract

摘要： 目的分析术前梗死脑组织/全脑体积比值与脑梗死患者去骨瓣减压术后预后的关系,旨在从神经影像学角度进一步探索脑梗死去骨瓣减压术后出现不良结局的危险因素。方法回顾性分析2019年1月至2022年9月中国科学技术大学附属第一医院(安徽省立医院)神经外科收治的因大脑半球大面积脑梗死行去骨瓣减压术患者的临床相关资料,使用3D Slicer软件重建并分析术前/术后的头颅CT影像学资料,旨在从神经影像学角度进一步探索脑梗死去骨瓣减压术后出现不良结局的危险因素。结果最终纳入接受去骨瓣减压术的大面积脑梗死临床病例42例,其中男性23例,女性19例;年龄36~68岁,平均(56.21±8.57)岁;GCS评分5~15分,平均(10.55±3.19)分,起始发病至术前3~1440小时,平均(121.48±230.77)小时。根据术后一个月的生存情况分为存活组(30例)和死亡组(12例),术前梗死脑组织体积(t=-2.260,P=0.029)、术前全脑体积(t=2.660,P=0.011)、术前梗死脑组织/全脑体积比(t=-3.724,P=0.001)、术后全脑体积(t=-2.464,P=0.018)、术后梗死脑组织/全脑体积比(Z=-2.589,P=0.010)、术后中线偏移距离指标(t=-2.484,P=0.017),组间比较差异具有统计学意义(P＜0.05)。二分类logistic回归分析提示较小的术前全脑体积、较大的术前梗死脑组织/全脑体积比是脑梗死患者去骨瓣减压术后短期内预后不良的危险因素。结论较大的术前梗死组织/全脑体积比、较小的术前全脑体积是大面积脑梗死去骨瓣减压术后死亡的危险因素。在大面积脑梗死患者治疗期间应该做好多模态影像监测,必要时尽早地给予充分减压,可能进一步降低病死率。

关键词: 大面积脑梗死, 3D Slicer, 三维重建, 去骨瓣减压术, 危险因素

Abstract: Objective Analyzing the relationship between the ratio of preoperative infarcted brain tissue volume to whole brain volume and the prognosis of patients with cerebral infarction after decompressive craniectomy,to explore the risk factors of the poor outcomes after decompressive craniectomy due to cerebral infarction based on this neuroiaging study.Methods The patients admitted to the department of neurosurgery,the first affiliated hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from January 2019 to September 2022 who underwent decompressive craniectomy for massive cerebral infarction in the cerebral hemisphere were selected,the clinical data were retrospectively analyzed,the cranial CT imaging data before and after surgery were reconstructed and analyzed using 3D Slicer software,with the aim of further exploring the risk factors of decompressive craniectomy for cerebral infarction from neuroimaging study.Results Forty-two clinical cases of massive cerebral infarction undergoing decompressive craniectomy were finally enrolled,including 23 males and 19 females;the age ranged from 36 to 68 years,with an average age of 56.21±8.57 years;the GCS score ranged from 5 to15 points,with an average age of 10.55±3.19 points,the time from emerging symptoms to operation is between 3 and 1440 hours,with an average time of 121.48±230.77 hours.The patients were divided into survival group (30 cases) and death group (12 cases) according to the survival condition one month after operation.The differences between groups were statistically significant (P＜0.05) for preoperative infarcted brain tissue volume(t=-2.260,P=0.029),the whole brain volume before surgery(t=2.660,P=0.011),the ratio of preoperative infarcted brain tissue volume to whole brain volume(t=-3.724,P=0.001),the whole brain volume after surgery(t=-2.464,P=0.018),the ratio of postoperative infarcted brain tissue to whole brain volume(Z=-2.589,P=0.010) and the postoperative midline offset distance(t=-2.484,P=0.017).Dichotomous logistic regression analysis suggested that preoperative whole brain volume and the ratio of preoperative infarcted brain tissue volume to whole brain volume were risk factors for poor prognosis in the short term after decompressive craniectomy.Conclusion The larger ratio of preoperative infarcted brain tissue volume to whole brain volume and smaller preoperative whole brain volume are risk factors for death after decompressive craniectomy due to large cerebral infarction.Therefore,multimodal imaging monitoring is recommended for patients with massive cerebral infarction,and adequate decompression is required to reduce the mortality rate.

Key words: Massive cerebral infarction, 3D Slicer, 3D reconstruction, Decompressive craniectomy, Risk factors

中图分类号:

R741

李政, 奚之玉, 鲍得俊, 牛朝诗. 术前梗死脑组织/全脑体积比值与脑梗死患者去骨瓣减压术后预后的关系[J]. 立体定向和功能性神经外科杂志, 2022, 35(6): 343-349.

Li Zheng, Xi Zhiyu, Bao Dejun, et al. A study assessing the relationship between the ratio of preoperative infarcted brain tissue volume to whole brain volume and the prognosis of patients with cerebral infarction after decompressive craniectomy[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(6): 343-349.

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