前循环大面积脑梗死的临床特征及其预后的危险因素分析
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摘要
目的探讨前循环大面积脑梗死(MCI)的临床特征及影响预后的高危因素。方法回顾性分析90例MCI患者临床资料,发病后1个月内死亡者纳入死亡组(n=26),未死亡者纳入存活组(n=64)。归纳MCI总体临床特征,分析影响预后的高危因素。结果 MCI多由高血压性脑动脉硬化及心源性脑栓塞所致,患者多存在头痛、呕吐、尿失禁、昏迷、中枢性高热等体征,部分还可伴发肺部感染或消化道出血,且存在不同程度的躯干、肢体感觉障碍,可伴有双眼偏向梗死灶侧凝视症状;发病后1个月内死亡率为28. 89%,死因为脑疝或多器官衰竭,存活患者后遗症严重,多以植物生存与不同程度瘫痪为主。高龄、脑室中线移位较大、继发肺部感染及单纯保守治疗是导致MCI患者死亡的独立危险因素(P <0. 05)。结论 MCI临床特征突出且病死率较高,故针对高龄、脑室中线较大移位、继发肺部感染及单纯采取保守治疗的患者需引起足够重视,以期最大程度改善其预后。
Objective To explore the clinical features of massive cerebral infarction( MCI) and the high-risk factors for prognosis.Methods The clinical data of 90 patients with MCI were retrospectively analyzed.The patients who died within 1 month after onset were included in death group( n = 26),and the patients who were survival were included in survival group( n = 64).The overall clinical features of MCI were summarized to analyze the high risk factors for prognosis of the patients.Results MCI was mostly caused by hypertensive cerebral arteriosclerosis and cardiogenic cerebral embolism. The patients were often with the signs of headache,vomiting,urinary incontinence,coma and central hyperpyrexia.Some patients might also be associated with pulmonary infection or gastrointestinal bleeding with different degrees of sensory disability of trunk and limbs,and they might be accompanied by staring symptoms on the lesion side of bilateral eyes.The mortality rate within 1 month after onset was 28. 89% due to cerebral palsy or multiple organ failure.Severe sequelae in survivors mostly included vegetable survival and different degrees of paralysis.Non-conditional logistic multivariate stepwise regression analysis showed that older age,greater midbrain displacement,secondary pulmonary infection and pure conservative treatment were independent risk factors for death in MCI patients( P < 0. 05).Conclusion MCI has prominent clinical features and high mortality rate.Therefore,patients with older age,greater midbrain displacement,secondary pulmonary infections and pure conservative treatment should be given adequate attention in order to maximize the prognosis.
Objective To explore the clinical features of massive cerebral infarction( MCI) and the high-risk factors for prognosis.Methods The clinical data of 90 patients with MCI were retrospectively analyzed.The patients who died within 1 month after onset were included in death group( n = 26),and the patients who were survival were included in survival group( n = 64).The overall clinical features of MCI were summarized to analyze the high risk factors for prognosis of the patients.Results MCI was mostly caused by hypertensive cerebral arteriosclerosis and cardiogenic cerebral embolism. The patients were often with the signs of headache,vomiting,urinary incontinence,coma and central hyperpyrexia.Some patients might also be associated with pulmonary infection or gastrointestinal bleeding with different degrees of sensory disability of trunk and limbs,and they might be accompanied by staring symptoms on the lesion side of bilateral eyes.The mortality rate within 1 month after onset was 28. 89% due to cerebral palsy or multiple organ failure.Severe sequelae in survivors mostly included vegetable survival and different degrees of paralysis.Non-conditional logistic multivariate stepwise regression analysis showed that older age,greater midbrain displacement,secondary pulmonary infection and pure conservative treatment were independent risk factors for death in MCI patients( P < 0. 05).Conclusion MCI has prominent clinical features and high mortality rate.Therefore,patients with older age,greater midbrain displacement,secondary pulmonary infections and pure conservative treatment should be given adequate attention in order to maximize the prognosis.
引文
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[6]杨雪,王丽华.依达拉奉联合rt-PA超时间窗治疗脑梗死的研究进展[J].卒中与神经疾病,2016,23(2):145-146.
[7]王新一,蔡增林,徐丙超,等.大面积脑梗死伴脑水肿患者的定量脑电图检测分析[J].蚌埠医学院学报,2015,40(12):1646-1648.
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[9]范琳娜.大面积脑梗死的常见病因及临床特点分析[J].实用心脑肺血管病杂志,2013,21(2):81-82.
[10]李红亮,宿英英,杨庆林,等.脑电图预测大面积脑梗死患者不良预后时机研究[J].中国现代神经疾病杂志,2015,15(12):950-955.
[11]孙凌瑜,黄灿,刘立雄,等.不同年龄段大面积脑梗死危险因素分析[J].国际老年医学杂志,2016,37(5):197-199.
[12]霍伟康,汪求精,宋昭,桂小娟.年龄、NIHSS评分在大面积脑梗死患者手术预后评价中的差异[J].广东医学,2017,38(S1):66-68.
[13]Flechsenhar J,Woitzik J,Zweckberger K,et al.Hemicraniectomy in the management of space-occupying ischemic stroke[J]. Journal of Clinical Neuroscience,2013,20(1):6-12.
[14]孙佳红,葛永玲,赵凤玲.幕上大面积脑梗死患者发生致死性脑水肿的早期预测因素[J].中国慢性病预防与控制,2015,23(07):550-552.
[15]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(11):1122-1127.
[2]刘宏伟,焦杰,应卫真.大面积脑梗死的诊治体会[J].实用心脑肺血管病杂志,2014,22(7):131-132.
[3]Torbey M T,BOsel J,Rhoney D H,et al.Evidence-Based Guidelines for the Management of Large Hemispheric Infarction[J].Neurocritical Care,2015,22(1):146-164.
[4]郑俊,罗福昌.三联药物方案对急性大面积脑梗死患者GCS评分、血红蛋白水平及不良反应的影响[J].血栓与止血学,2017,23(5):733-736.
[5]杨辉.依达拉奉联合脑蛋白水解物治疗老年大面积脑梗死的临床研究[J].成都医学院学报,2014,9(1):31-34.
[6]杨雪,王丽华.依达拉奉联合rt-PA超时间窗治疗脑梗死的研究进展[J].卒中与神经疾病,2016,23(2):145-146.
[7]王新一,蔡增林,徐丙超,等.大面积脑梗死伴脑水肿患者的定量脑电图检测分析[J].蚌埠医学院学报,2015,40(12):1646-1648.
[8]宋晓征,李成杰.依达拉奉联合吡拉西坦用于大面积脑梗死效果观察[J].山东医药,2015,55(10):39-40.
[9]范琳娜.大面积脑梗死的常见病因及临床特点分析[J].实用心脑肺血管病杂志,2013,21(2):81-82.
[10]李红亮,宿英英,杨庆林,等.脑电图预测大面积脑梗死患者不良预后时机研究[J].中国现代神经疾病杂志,2015,15(12):950-955.
[11]孙凌瑜,黄灿,刘立雄,等.不同年龄段大面积脑梗死危险因素分析[J].国际老年医学杂志,2016,37(5):197-199.
[12]霍伟康,汪求精,宋昭,桂小娟.年龄、NIHSS评分在大面积脑梗死患者手术预后评价中的差异[J].广东医学,2017,38(S1):66-68.
[13]Flechsenhar J,Woitzik J,Zweckberger K,et al.Hemicraniectomy in the management of space-occupying ischemic stroke[J]. Journal of Clinical Neuroscience,2013,20(1):6-12.
[14]孙佳红,葛永玲,赵凤玲.幕上大面积脑梗死患者发生致死性脑水肿的早期预测因素[J].中国慢性病预防与控制,2015,23(07):550-552.
[15]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(11):1122-1127.