Clinical application of intracranial pressure related parameters after decompressive craniectomy for massive cerebral infarction
Objective To explore the clinical application value of intracranial pressure(ICP)related parameters in patients with massive supratentorial cerebral infarction after decompressive craniecto-my(DC).Methods From June 2018 to June 2023,186 patients with large-area cerebral infarction who underwent DC in Department of Neurosurgery of Henan Provincial People's Hospital were randomly divided into an ICP group(93 cases)and a control group(93 cases)using a random number method.During DC surgery,intracranial pressure probes were placed in the ICP group for 5-7 days,and ICP values,the corre-lation coefficient(RAP)between ICP amplitude and ICP,and the pressure related index(PRx)were moni-tored and recorded.The clinical data differences between the two groups were compared,and the occur-rence of adverse events was analyzed.The Kaplan-Meier method was used for survival analysis,and the 30-day survival was observed.At 6th month after surgery,the ICP group was divided into a good prognosis subgroup(0-4 grades,55 cases)and a poor prognosis subgroup(5-6 grades,38 cases)based on the im-proved Rankin scale evaluation.Univariate analysis was used to compare the clinical data and differences in ICP,RAP,and PRx between the two groups.Multivariate logistic regression was used to analyze the independent adverse factors affecting the prognosis of patients.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of ICP related parameters for prognosis.Results Compared with the control group,the length of ICU stay,incidence of pulmonary infection and incidence of electrolyte disturbance in the ICP group were lower than those in the control group(14.37±2.83,53.8％,16.1％vs.17.59±3.04,78.5％,30.1％,t=1.362,x2=0.614,1.023,P＜0.05),the incidence of postoperative cerebral hemorrhage,postoperative cerebral infarction and intracranial infection was higher than that of the control group(11.8％,9.7％,9.7％vs.9.7％,8.6％,10.8％).Kaplan-Meier survival analysis showed that the 30 day survival rate in ICP group was higher than that in control group(81.7％vs.71.0％,x2=3.980,P＜0.05).The ICP,RAP and PRx in the good prognosis subgroup were lower than those in the poor prognosis subgroup[(11.9±2.4,0.31±0.12,0.18±0.16)vs.(17.8±2.2,0.46±0.17,0.29±0.17),t=-1.547,0.105,0.355,P＜0.05].Multivariate Logistic regression showed that ICP,RAP and PRx were independent adverse factors affecting prognosis.The partial regression coefficients of ICP,RAP and PRx were 0.946,1.037 and 1.102,respectively,and Wald values were 6.372,1.207 and 1.326,respec-tively.95％confidence interval(CI)was 1.017-7.051,1.113-9.974,and 1.106-11.538[odds ratio(OR)=0.068,1.207,1.326,P＜0.05],respectively.ICP,RAP and PRx had predictive value for progno-sis of large-area cerebral infarction after DC,and their predictive effects were consistent,and the areas under the curve were 0.902(95％CI:0.841-0.963),0.802(95％CI:0.715-0.889)and 0.933(95％CI:0.871-0.995);the Yoden index was 0.654,0.478 and 0.804;the best diagnostic threshold was 13.50,0.29 and 0.20;the corresponding sensitivity was 76.3％,84.2％and 89.5％,and the specificity was 89.1％,63.6％and 90.9％,respectively.Conclusion The application of ICP related parameters in pa-tients with large-area cerebral infarction after DC can shorten the length of ICU hospitalization,reduce com-plications,improve early survival rate,and have good predictive value for prognosis.
Cerebral infarctionDecompression surgery with bone flap removalIntracranial pressure
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