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目的分析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,为临床决策提供科学依据。方法回顾性研究幕上大面积脑梗死患者发病的临床、实验室、脑彩超和结构影像学因素,发病1周内死于严重脑水肿导致颞叶沟回疝的患者为死亡组,共42例,其余存活者为存活组,共23例。结果经单变量统计分析,两组患者在发病48 h内出现的昏迷程度加重(Glasgow评分下降)、体温、血糖、外周血白细胞(WBC)计数、脑梗死范围、脑血流和颅内压变化6项因素,差异均有统计学意义(P<0.05,P<0.01),进行多元因素logistic回归分析显示,两组在昏迷、脑梗死范围≥3个脑叶和颅内压增高变化3项因素差异均有统计学意义(P>0.05)。结论 Glasgow评分进行性下降、脑梗死范围≥3个脑叶和血流速度下降、血管搏动指数(PI)值进行性增加3项因素可能是大面积脑梗死患者出现致死性脑水肿的早期独立预测因素。
Objective To analyze the early predictors of lethal brain edema in patients with supratentorial large area cerebral infarction and provide a scientific basis for clinical decision-making. Methods A retrospective study of clinical, laboratory, cerebral ultrasonography and structural imaging factors in patients with supratentorial large area cerebral infarction patients died of severe brain edema within 1 week of the patients with temporal lobar dorsal hernia was the death group, a total of 42 cases , The remaining survivors were survival group, a total of 23 cases. Results Univariate statistical analysis showed that coma increased (Glasgow score decreased), body temperature, blood glucose, WBC count, cerebral infarction range, cerebral blood flow and intracranial pressure 6 factors, the differences were statistically significant (P <0.05, P <0.01), multivariate logistic regression analysis showed that the two groups in the coma, cerebral infarction range ≥ 3 brain lobes and increased intracranial pressure changes in three factors The differences were statistically significant (P> 0.05). Conclusions The progressive decrease of Glasgow score, the decrease of cerebral lobe area> 3 lobes and the decrease of blood flow velocity and the progressive increase of vascular pulsatility index (PI) may be the early independent predictors of fatal cerebral edema in patients with large area cerebral infarction factor.