大脑中动脉供血区大面积脑梗死患者脑疝危险因素的分析

目的分析大脑中动脉供血区大面积脑梗死（MMCI）患者出现致死性脑水肿的危险因素。方法回顾性分析单中心2002年8月—2011年1月137例MMCI患者的临床资料。根据病程中患者是否发生脑疝，分为脑疝组48例、非脑疝组89例。对可能影响脑水肿的危险因素进行分析。结果出院时死亡46例，脑疝组36例，非脑疝组10例。存活的91例患者，均遗留肢体瘫痪。①单因素分析显示，脑疝组心房颤动、凝视、吸烟、收缩压、美国国立卫生研究院卒中量表评分、Barthel指数均高于非脑疝组，差异均有统计学意义（均P〈0．05）；脑疝组格拉斯哥昏迷评分（GCS）低于非脑疝组，差异有统计学意义（P〈0．01）。②多变量Logistic回归分析显示，吸烟（OR=3．391，95％CI：1．339～30．505）、GCS评分（OR：0．684，95％C1：0．554—0．844）、收缩压水平（OR=1．027，95％C1：1．006～1．049）与脑疝的发生显著相关。结论合并心房颤动的MMCI患者更易发生急性脑水肿导致脑疝。吸烟、GCS评分、收缩压水平可能是MMCI患者出现脑疝的危险因素。

Analysis of the risk factors for cerebral hernia in patients with large area infarction of middle cerebral artery

Objective To analyze the risk factors for fatal brain edema in patients with large area infarction of middle cerebral artery （malignant middle cerebral artery territory infarction, MMCI ）. Methods The clinical data of 137 patients with MMCI from August 2002 to January 2011 were analyzed retrospectively. They were divided into brain hernia group （ n = 48 ） and non-hernia group （ n = 89 ） according to whether they had brain hernia or not in the course of disease. The possible risk factors for brain edema were analyzed. Results Forty-six patients were died, 36 patients in the hernia group and 10 patients in the non-hernia group; 91 patients survived, but all left limb paralysis. ①The univariate analysis showed that the percentage of atrial fibrillation, staring, smoking, high systolic blood pressure, National Institutes of Health Stroke Scale （NIHSS） score and barthel index （BI） index in the hernia group were all higher than those in the non-hernia group. The differences were statistically significant （ all P 〈 0.05 ） ; the Glasgow Coma Scale （GCS） score in the hernia group was lower than that in the non-hernia group （P 〈 0. 01 ）. ②Multivariate logistic regression analysis showed that smoking （ OR, 3. 391 ; 95% CI, 1. 339 to 30. 505） , GCS score （OR, 0. 684, 95% CI, 0. 554 to 0. 844） and systolic blood pressure level （OR, 1. 027, 95% CI, 1. 006 to 1. 049 ） were significantly correlated with the occurrence of brain edema. Conclusion The patients with MMCI combined with atrial fibrillation are more susceptible to acute cerebral edema caused brain hernia. Smoking, GCS score and high systolic blood pressure level may be the risk factors for cerebral hernia.