去骨瓣减压术治疗大脑中动脉脑卒中后癫发作的高危因素分析
摘要
目的探讨去骨瓣减压术(DHC)治疗大脑中动脉(MCA)脑卒中后癫发作的高危因素。方法 60例接受DHC治疗的MCA脑卒中患者,根据术后6个月有无癫发作分为癫发作组(32例)和无癫发作组(28例)。收集临床资料和实验室数据,应用单因素、多因素非条件Logistic回归分析方法探讨影响DHC治疗MCA脑卒中患者术后癫发作的危险性因素。结果术前急性生理与慢性健康评分(APACHEⅡ)>19分、出血量>245.50 cm~3、同型半胱氨酸(Hcy)>17.35μmol·L~(-1)、N端脑钠肽前体(NT-pro BNP)>375.25 ng·L~(-1)、C反应蛋白(CRP)>12.08 mg·L~(-1)、基质金属蛋白酶-9(MMP-9)>99.65μg·L~(-1)增加DHC治疗MCA脑卒中患者术后癫发作的风险(P<0.05)。结论 DHC治疗MCA脑卒中患者术后癫发作与术前APACHEⅡ评分、出血量及Hcy、NT-pro BNP、CRP、MMP-9水平密切相关。
引文
[1]Pitk?nen A,Roivainen R,Lukasiuk K.Development of epilepsy after ischaemic stroke[J].Lancet Neurol,2015,15:185-197
[2]Brondani R,Garcia de Almeida A,Abrahim Cherubini P,et al.High Risk of Seizures and Epilepsy after Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke[J].Cerebrovasc Dis Extra,2017,7:51-61
[3]Jüttler E,Unterberg A,Woitzik J,et al.Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke[J].N Engl J Med,2014,370:1091-1100
[4]王艳,肖哲曼,陈康,等.去骨瓣减压术与保守疗法治疗恶性大脑中动脉脑梗死疗效的Meta分析[J].中华神经医学杂志,2015,14:1122-1127
[5]Recommendations on stroke prevention,diagnosis,and therapy.Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders[J].Stroke,1989,20:1407-1431
[6]中华神经外科学会神经创伤专业组.颅脑创伤去骨瓣减压术中国专家共识[J].中华神经外科杂志,2013,29:967-969
[7]胡晓,李玫,瞿浩,等.去骨瓣减压术治疗大脑中动脉供血区恶性梗死的临床观察[J].临床神经病学杂志,2016,29:321-325
[8]冯瑞,宋云龙,毕永民,等.640层容积CT 4D-CTA技术在脑血管病成像中的应用[J].中国医学影像技术,2016,32:492-495
[9]Moon BH,Park SK,Jang DK,et al.Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients[J].J Clin Neurosci,2015,22:111-115
[10]Pietraszek-Grzywaczewska I,Bernas S,kojko P,et al.Predictive value of the APACHE II,SAPS II,SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis[J].Anaesthesiol Intensive Ther,2016,48:175-179
[11]余勇飞,魏衡,周瑞,等.去骨瓣减压术治疗恶性大脑中动脉脑梗死疗效的Meta分析[J].中华临床医师杂志:电子版,2013,7:1669-1673
[12]Jüttler E,Unterberg A,Woitzik J,et al.Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke[J].N Engl J Med,2014,370:1091-1100
[13]Wijdicks EF,Sheth KN,Carter BS,et al.Recommendations for the management of cerebral and cerebellar infarction with swelling:a statement for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45:1222-1238
[14]Tsai CL,Chu H,Peng GS,et al.Preoperative APACHE II and GCS scores as predictors of outcomes in patients with malignant MCA infarction after decompressive hemicraniectomy[J].Neurol India,2012,60:608-612
[15]赵文俊.中风后继发癫的临床资料分析[J].中西医结合心血管病电子杂志,2015,3:55-56
[16]吴学平,杨昌勤,吴学毅,等.血清同型半胱氨酸及白介素-6(IL-6)水平与缺血性卒中患者认知功能障碍的相关性及临床价值[J].中国免疫学杂志,2016,32:734-736
[17]Terse PS,Joshi PS,Bordelon NR,et al.2-Deoxy-d-Glucose(2-DG)-Induced Cardiac Toxicity in Rat:NT-pro BNP and BNP as Potential Early Cardiac Safety Biomarkers[J].Int J Toxicol,2016,35:284-293
[18]兰卫明,麻乐乐.缺血性脑卒中患者血清Chemerin因子表达及其临床意义[J].中国临床药理学杂志,2016,32:1353-1355
[19]张小菊,王荔,高建英,等.高脂血症对脑缺血再灌注大鼠脑组织中MMP-9和COX-2表达的影响[J].中国临床神经科学,2011,19:270-275
[20]刘晓勇,张世明.大鼠脑缺血再灌注后MMP-9的表达及人工合成E-选择素的干预作用[J].中国临床神经科学,2010,18:119-125
[21]Chaturvedi M,Kaczmarek L.Mmp-9 inhibition:a therapeutic strategy in ischemic stroke[J].Mol Neurobiol,2014,49:563-573
[22]Kurzepa J1,Kurzepa J,Golab P,et al.The significance of matrix metalloproteinase(MMP)-2 and MMP-9 in the ischemic stroke[J].Int J Neurosci,2014,124:707-716.
[2]Brondani R,Garcia de Almeida A,Abrahim Cherubini P,et al.High Risk of Seizures and Epilepsy after Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke[J].Cerebrovasc Dis Extra,2017,7:51-61
[3]Jüttler E,Unterberg A,Woitzik J,et al.Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke[J].N Engl J Med,2014,370:1091-1100
[4]王艳,肖哲曼,陈康,等.去骨瓣减压术与保守疗法治疗恶性大脑中动脉脑梗死疗效的Meta分析[J].中华神经医学杂志,2015,14:1122-1127
[5]Recommendations on stroke prevention,diagnosis,and therapy.Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders[J].Stroke,1989,20:1407-1431
[6]中华神经外科学会神经创伤专业组.颅脑创伤去骨瓣减压术中国专家共识[J].中华神经外科杂志,2013,29:967-969
[7]胡晓,李玫,瞿浩,等.去骨瓣减压术治疗大脑中动脉供血区恶性梗死的临床观察[J].临床神经病学杂志,2016,29:321-325
[8]冯瑞,宋云龙,毕永民,等.640层容积CT 4D-CTA技术在脑血管病成像中的应用[J].中国医学影像技术,2016,32:492-495
[9]Moon BH,Park SK,Jang DK,et al.Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients[J].J Clin Neurosci,2015,22:111-115
[10]Pietraszek-Grzywaczewska I,Bernas S,kojko P,et al.Predictive value of the APACHE II,SAPS II,SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis[J].Anaesthesiol Intensive Ther,2016,48:175-179
[11]余勇飞,魏衡,周瑞,等.去骨瓣减压术治疗恶性大脑中动脉脑梗死疗效的Meta分析[J].中华临床医师杂志:电子版,2013,7:1669-1673
[12]Jüttler E,Unterberg A,Woitzik J,et al.Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke[J].N Engl J Med,2014,370:1091-1100
[13]Wijdicks EF,Sheth KN,Carter BS,et al.Recommendations for the management of cerebral and cerebellar infarction with swelling:a statement for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45:1222-1238
[14]Tsai CL,Chu H,Peng GS,et al.Preoperative APACHE II and GCS scores as predictors of outcomes in patients with malignant MCA infarction after decompressive hemicraniectomy[J].Neurol India,2012,60:608-612
[15]赵文俊.中风后继发癫的临床资料分析[J].中西医结合心血管病电子杂志,2015,3:55-56
[16]吴学平,杨昌勤,吴学毅,等.血清同型半胱氨酸及白介素-6(IL-6)水平与缺血性卒中患者认知功能障碍的相关性及临床价值[J].中国免疫学杂志,2016,32:734-736
[17]Terse PS,Joshi PS,Bordelon NR,et al.2-Deoxy-d-Glucose(2-DG)-Induced Cardiac Toxicity in Rat:NT-pro BNP and BNP as Potential Early Cardiac Safety Biomarkers[J].Int J Toxicol,2016,35:284-293
[18]兰卫明,麻乐乐.缺血性脑卒中患者血清Chemerin因子表达及其临床意义[J].中国临床药理学杂志,2016,32:1353-1355
[19]张小菊,王荔,高建英,等.高脂血症对脑缺血再灌注大鼠脑组织中MMP-9和COX-2表达的影响[J].中国临床神经科学,2011,19:270-275
[20]刘晓勇,张世明.大鼠脑缺血再灌注后MMP-9的表达及人工合成E-选择素的干预作用[J].中国临床神经科学,2010,18:119-125
[21]Chaturvedi M,Kaczmarek L.Mmp-9 inhibition:a therapeutic strategy in ischemic stroke[J].Mol Neurobiol,2014,49:563-573
[22]Kurzepa J1,Kurzepa J,Golab P,et al.The significance of matrix metalloproteinase(MMP)-2 and MMP-9 in the ischemic stroke[J].Int J Neurosci,2014,124:707-716.