摘要
目的 探讨定向置管抽吸坏死脑组织治疗≥61岁恶性大脑中动脉梗死患者的疗效和安全性.方法 回顾性分析盐城市第三人民医院、盐城市第一人民医院、淮安市第一人民医院3个中心2016年1月至2024年5月102例大于60岁且确诊为恶性大脑中动脉梗死患者,分别收集经内科保守治疗(保守组)58例,定向置管抽吸坏死脑组织治疗(抽吸组)44例.比较两组近远期疗效和并发症的发病率:发病1个月的存活率,早期脑疝、颅内血肿、颅内感染等并发症发生率;随访6个月,分析两组的mRS评分分布,远期预后良好率(mRS 0～3),非重残生存率(mRS 0～4)和病死率.将患者分为预后良好组(mRS 0-3)与预后不良组(mRS 4～6),采用二元Logisitic回归分析两种不同治疗方法对远期预后良好的影响.结果 抽吸组和保守组在年龄,性别,吸烟史,饮酒史,房颤,糖尿病,发病24h的GCS,发病后24 h的NIHSS评分,24～30 h的梗死体积上差异无统计学意义(P＞0.05);保守组和抽吸组合并高血压病的比率分别为46.6％、25.0％(x2=4.971,P=0.026),差异有统计学意义.两组经治疗后1个月内,术后颅内血肿和术后颅内感染发生率差异无统计学意义(P＞0.05);抽吸组早期脑疝发生率和病死率均显著低于保守组,分别为9.1％vs.48.3％(x2=17.843,P＜0.001)和 13.6％vs.60.3％(x2=22.707,P＜0.001).6 个月随访,两组mRS分布差异有统计学意义(P＜0.001),抽吸组的预后良好(mRS 0～3)率显著高于保守组(38.6％vs.3.4％,x2=20.438,P＜0.001),非重残生存(mRS 0～4)率显著高于保守组(68.2％vs.22.4％,x2=21.492,P＜0.001).抽吸组6个月的病死率显著低于保守组,分别为20.5％vs.65.5％(x2=20.448,P＜0.001).6个月的预后良好(mRS 0～3)与预后不良(mRS 4～6)的单因素分析显示,预后良好率抽吸组和保守组分别为89.5％和10.5％(P＜0.001),差异有统计学意义;以预后良好和不良作为因变量,通过多因素Logisitic回归分析,校正吸烟、糖尿病、房颤、发病24h的GCS评分和NIHSS评分等混杂因素,结果显示治疗方式仍然是影响老年恶性大脑中动脉梗死6个月预后的独立因素(保守组vs.抽吸组P＜0.001,OR=126.704,95％CI:7.236～2218.610).结论 研究初步显示立体定向抽吸坏死脑组织可以降低老年MMI患者病死率和改善预后,并具有安全性.
Abstract
Objective To explore the effect and safety of stereotactic aspiration of necrotic brain tissue for the patients ≥ 61 years with malignant middle cerebral artery infarction(MMI).Methods A total of 102 MMI patients aged ≥ 61 years were enrolled retrospectively.All patients were subject to conservative medical treatment alone or in addition to stereotactic aspiration of necrotic brain tissue 24-72 hours after symptom onset.Perioperative outcomes and 6-month follow-up outcomes were observed and evaluated.Results Baseline data characteristics were well balanced between the conservative treat group and aspiration group,except for the prevalence of hypertension.The incidence of early cerebral herniation(9.1％vs.48.3％,x2=17.843,P＜0.001)and death(13.6％vs.60.3％,x2=22.707,P＜0.001)in the aspiration group was significantly lower than that in the conservative group,and there was no significant difference in the incidence of cerebral hemorrhage(P=0.726)and intracranial infection(P=0.186)between the groups.At 6-month follow-up,compared with the conservative treatment group,the aspiration group had a higher proportion of favorable outcome(mRS 0-3)(38.6％vs.3.4％,x2=20.438,P＜0.001)and survival without severe disability(mRS 0-4)(68.2％vs.22.4％,x2=21.492,P＜0.001).Comparison of clinical characteristics of favorable outcome(mRS 0-3)group and unfavorable(mRS 4-6)group showed that the proportion of patients treated with aspiration was significantly higher than that treated with medical therapy alone(89.5％vs.10.5％,P＜0.001).Multivariate logisitic regression used to adjust the confound factors such as atrial fibrillation,diabetes and smoking,the GCS and the NIHSS score of 24 hours after onset,etc,revealed that the treatment with aspiration was an independent association factor for the ratio of 6-month favorable outcome for the elderly patients with MMI(OR=126.704,95％CI:7.236-2218.610,P＜0.001).Conclusions The stereotactic aspiration of necrotic brain tissue are effective and safe for the elderly patients with MMI.
维普
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