论文部分内容阅读
目的:探讨大脑中动脉（MCA）M1段闭塞所致急性大脑半球大面积梗死（LHI）患者预后与脑血流分流现象的关联性。方法:选择陕西省安康市中心医院2015年5月至2018年5月收治的182例MCA M1段闭塞急性LHI患者，均于入院早期时接受经颅患者多普勒检查，依据患者是否存在脑血流分流现象分为分流组（69例）及无分流组（113例），对两组患者院内死亡、发病后3、6和12个月预后情况进行统计分析。结果:与分流组比较，无分流组患者中线移位[41.6%（47/113）比15.9%（11/69）]、机械辅助通气[32.7%（37/113）比8.7%（6/69）]、院内死亡[26.5%（30/113）比8.7%（6/69）]以及发病后3个月[94.7%（107/113）比66.7%（46/69）]、6个月[72.6%（82/113）比46.4%（32/69）]、12个月[72.6%（82/113）比43.5%（30/69）]预后不良的发生率均显著升高，差异有统计学意义（n P<0.05）。多因素分析提示是否存在脑血流分流现象是中线移位（n OR=28.721，95% n CI 1.933 ~ 35.807）、机械通气（n OR=11.162，95% n CI 1.625 ~ 17.029）、患者发病3个月（n OR=20.052，95% n CI 3.059 ~ 23.375）、发病6个月（n OR=3.536，95% n CI 1.164 ~ 10.784）、发病12个月（n OR=4.412，95% n CI 1.398 ~ 13.971）不良结局的危险因素（n P<0.05）。n 结论:脑血流分流与MCA M1段闭塞所致急性LHI患者的短期及长期预后相关。“,”Objective:To analyze the relationship between cerebral blood flow diversion and prognosis of patients with acute large hemispheric infarction (LHI) caused by middle cerebral artery (MCA) M1 segment occlusion.Methods:From May 2015 to May 2018, 182 patients with acute LHI caused by MCA M1 segment occlusion in Ankang Central Hospital were selected. All patients underwent cranial Doppler examination at the early stage of admission. They were divided into flow diversion group (69 cases) and non-flow diversion group (113 cases) according to the condition of cerebral blood flow diversion. The hospital mortality, prognosis at 3, 6 and 12 months after onset in the two groups were analyzed statistically.Results:Compared with those in flow diversion group, the incidence of midline shift[41.6%(47/113) vs. 15.9%(11/69)], mechanical ventilation [32.7%(37/113) vs. 8.7%(6/69)], hospital death [26.5%(30/113) vs. 8.7%(6/69)] and adverse outcomes of 3 months [94.7%(107/113) vs. 66.7% (46/69)], 6 months [72.6%(82/113) vs. 46.4%(32/69)], 12 months [72.6%(82/113) vs. 43.5%(30/69)] after onset in non-flow diversion group were increased significantly (n P<0.05). Multivariate analysis indicated cerebral blood flow diversion was a risk factor for midline shift (n OR=28.721, 95% n CI 1.933-35.807), mechanical ventilation (n OR=11.162, 95% n CI 1.625-17.029), and poor outcomes at 3 months of onset (n OR=20.052, 95% n CI 3.059-23.375), 6 months of onset (n OR=3.536, 95% n CI 1.164-10.784) and 12 months of onset (n OR=4.412, 95% n CI 1.398-13.971) (n P<0.05).n Conclusions:The short-term and long-term prognosis of patients with acute LHI caused by MCA M1 segment occlusion can be predicted by the presence of cerebral blood flow diversion in transcranial Doppler examination of the early stage.