王猛;张永光;高艺博;

• 1:周口市中医院

摘要(Abstract)：

目的分析老年小脑梗死患者经颅后窝减压术治疗后发生出血转化的影响因素,为术后出血转化的预防提供指导,以改善患者预后。方法回顾分析2015-01—2020-01周口市中医院老年小脑梗死患者的临床资料,从中筛选符合条件的60例患者为研究对象。颅后窝减压术后48 h内定时复查头颅CT,统计出血转化发生情况及患者基线资料,包括性别、年龄、格拉斯哥昏迷量表(GCS)评分、梗死灶直径、术前溶栓情况及有无高血压、糖尿病、高脂血症、冠心病、房颤史;统计术前患者的血清纤维蛋白原(FIB)、同型半胱氨酸(Hcy)、基质金属蛋白酶9(MMP-9)、胶质纤维酸性蛋白(GFAP)水平,经单因素与多因素分析老年小脑梗死患者颅后窝减压术后出血转化的影响因素。结果 60例老年小脑梗死患者经颅后窝减压术治疗后14例发生出血转化,发生率23.33%;将全部可能的影响因素纳入,经单因素与多因素分析,结果显示梗死灶直径≥5 cm、房颤史与术前血清MMP-9、GFAP高表达是老年小脑梗死患者颅后窝减压术后出血转化的影响因素(OR>1,P<0.05)。结论梗死灶直径≥5 cm、有房颤史、术前血清MMP-9、GFAP高表达均可导致老年小脑梗死患者颅后窝减压术后出血转化风险升高,临床可据此进行合理的术前干预,以降低患者术后出血转化风险,可能对改善患者预后有积极意义。

关键词(KeyWords)： 小脑梗死;颅后窝减压术;出血转化;影响因素;老年

Abstract:

Keywords:

基金项目(Foundation): 河南省中医药科学研究专项课题(编号:2016ZY3047)

作者(Authors): 王猛;张永光;高艺博;

参考文献(References)：

• [1] SADIQ W,SUBHAN M.Ischemic Stroke of Midbrain and Cerebellum Involving Reticular Activating System[J].Cureus,2017,9(9):e1637.DOI:10.7759/cureus.1637.
• [2] 刘琦,郝东宁,宋彦彬.后颅窝去骨瓣减压加侧脑室额角穿刺置 Ommaya 囊治疗大面积小脑梗死的疗效[J].中国实用神经疾病杂志,2015,18(15):71-72.DOI:10.3969/j.issn.1673-5110.2015.15.044.
• [3] GUENEGO A,LECLER A,RAYMOND J,et al.Hemorrhagic Transformation After Stroke:Inter-And Intrarater Agreement[J].Eur J Neurol,2019,26(3):476-482.DOI:10.1111/ene.13859.
• [4] XU Z J,YU D F,XU H,et al.Study on the risk factors for hemorrhagic transformation of cerebellar infarction after posterior fossa decompression surgery[J].Zhonghua Yi Xue Za Zhi,2019,99(5):380-383.DOI:10.3760/cma.j.issn.0376-2491.2019.05.012.
• [5] SAKAMOTO Y,KIMURA K,IGUCHI Y,et al.Hemorrhagic transformation in acute cerebellar infarction[J].Cerebrovasc Dis,2011,32(4):327-333.DOI:10.1159/000329259.
• [6] DASHYAN V G,KHODYKIN E A,NIKITIN A S,et al.Malignant cerebellar infarction:clinical course and surgical treatment[J].Zh Nevrol Psikhiatr Im S S Korsakova,2019,119(8.Vyp.2):75-83.DOI:10.17116/jnevro201911908275.
• [7] MALINGER G,ZAHALKA N,KIDRON D,et al.Fatal outcome following foetal cerebellar haemorrhage associated with placental thrombosis[J].Eur J Paediatr Neurol,2006,10(2):93-96.DOI:10.1016/j.ejpn.2006.02.002.
• [8] TEASDALE G,MAAS A,LECKY F,et al.The Glasgow Coma Scale at 40 Years:Standing the Test of Time[J].Lancet Neurol,2014,13(8):844-854.DOI:10.1016/S1474-4422(14)70120-6.
• [9] VALENTINO F,GENTILE L,TERRUSO V,et al.Frequency and Determinants for Hemorrhagic Transformation of Posterior Cerebral Stroke:Posterior Ischemic Stroke and Hemorrhagic Transformation[J].BMC Res Notes,2017,10(1):592.DOI:10.1186/s13104-017-2889-x.
• [10] DESILLES J P,SYVANNARATH V,OLLIVIER V,et al.Exacerbation of Thromboinflammation by Hyperglycemia Precipitates Cerebral Infarct Growth and Hemorrhagic Transformation[J].Stroke,2017,48(7):1932-1940.DOI:10.1161/STROKEAHA.117.017080.
• [11] CASTRO P,AZEVEDO E,SERRADOR J,et al.Hemorrhagic Transformation and Cerebral Edema in Acute Ischemic Stroke:Link to Cerebral Autoregulation[J].J Neurol Sci,2017,372(1):256-261.DOI:10.1016/j.jns.2016.11.065.
• [12] BAR B,BILLER J.Select Hyperacute Complications of Ischemic Stroke:Cerebral Edema,Hemorrhagic Transformation,and Orolingual Angioedema Secondary to Intravenous Alteplase[J].Expert Rev Neurother,2018,18(10):749-759.DOI:0.1080/14737175.2018.1521723.
• [13] ARAUZ A,RUIZ-NAVARRO F,BARBOZA M A,et al.Outcome,Recurrence and Mortality After Non-Valvular Atrial Fibrillation Stroke:Long-Term Follow-Up Study[J].J Vasc Interv Neurol,2017,9(6):5-11.
• [14] LEHTOLA H,AIRAKSINEN K E J,HARTIKAINEN P,et al.Stroke Recurrence in Patients With Atrial Fibrillation:Concomitant Carotid Artery Stenosis Doubles the Risk[J].Eur J Neurol,2017,24(5):719-725.DOI:10.1111/ene.13280.
• [15] WEYMANN A,SABASHNIKOV A,ALI-HASAN-AL-SAEGH S,et al.Predictive Role of Coagulation,Fibrinolytic,and Endothelial Markers in Patients with Atrial Fibrillation,Stroke,and Thromboembolism:A Meta-Analysis,Meta-Regression,and Systematic Review[J].Med Sci Monit Basic Res,2017,23(1):97-140.DOI:10.12659/MSMBR.902558.
• [16] LAGARES A,PUTMAN C M,OGILVY C S.Posterior fossa decompression and clot evacuation for fourth ventricle hemorrhage after aneurysmal rupture:case report[J].Neurosurgery,2001,49(1):208-211.DOI:10.1097/00006123-200107000-00033.
• [17] 张方,李文杰.基质金属蛋白酶-9与急性脑出血后脑水肿的相关性研究[J].中国实用神经疾病杂志,2016,19(7):77-79.DOI:10.3969/j.issn.1673-5110.2016.07.046.
• [18] UNDERLY R G,LEVY M,HARTMANN D A,et al.Pericytes as Inducers of Rapid,Matrix Metalloprotein-ase-9-Dependent Capillary Damage During Ischemia[J].J Neurosci,2017,37(1):129-140.DOI:10.1523/JNEUROSCI.2891-16.2016.
• [19] BENES L,KAPPUS C,SURE U,et al.Treatment of a partially thrombosed giant aneurysm of the vertebral artery by aneurysm trapping and direct vertebral artery-posterior inferior cerebellar artery end-to-end anastomosis:technical case report[J].Neurosurgery,2006,59(1 Suppl 1):ONSE166-ONSE167.DOI:10.1227/01.NEU.0000220034.08995.37.
• [20] LUGER S,WITSCH J,DIETZ A,et al.Glial Fibrillary Acidic Protein Serum Levels Distinguish Between Intracerebral Hemorrhage and Cerebral Ischemia in the Early Phase of Stroke[J].Clin Chem,2017,63(1):377-385.DOI:10.1373/clinchem.2016.263335.
• [21] ZHANG S Q,WANG W,MA X L,et al.Anticoagulation therapy is harmful to large-sized cerebellar infarction[J].CNS Neurosci Ther,2014,20(9):867-873.DOI:10.1111/cns.12299.
• [23] HSIAO M C,LEE J D,LEE M,et al.Massive pontine hemorrhagic transformation associated with an anticoagulant for basilar artery occlusion[J].Neurol India,2006,54(4):431-433.DOI:10.4103/0028-3886.28123.
• [23] VENDRELL M,VALERO R,MERCADAL J,et al.Cerebrovascular accident with haemorrhagic transformation in a patient on antiplatelet treatment subjected to surgery of a hypophyseal macroadenoma[J].Rev Esp Anestesiol Reanim,2012,59(8):448-451.DOI:10.1016/j.redar.2012.06.003.
• [24] 耿春生,杨伟民,张丽,等.青年急性脑梗死患者的危险因素及病因分型分析[J].中国实用神经疾病杂志,2020,23(4):277-281.DOI:10.12083/SYSJ.2020.04.058.
• [25] 尹帅领,王海波,康泰,等.多模式影像指导下超时间窗的前循环大血管闭塞急性脑梗死患者血管内治疗单中心临床经验[J].中国实用神经疾病杂志,2020,23(9):803-807.DOI:10.12083/SYSJ.2020.09.128.
• [26] DUARTE E,MESSAGGI-SARTOR M,GRAU-SáNCHEZ J,et al.Cerebral infarct site and affected vascular territory as factors in breathing weakness in patients with subacute stroke[J].J Rehabil Med,2020 Oct 12.DOI:10.2340/16501977-2751.
• [27] BROOCKS G,ELSAYED S,KNIEP H,et al.Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake[J].Neurosurgery,2020:nyaa438.DOI:10.1093/neuros/nyaa438.
• [28] WANG T,ZHANG J,ZOU D,et al.Massive Brainstem and Cerebellum Infarction Due to Traumatic Extracranial Vertebral Artery Dissection in a Motor Traffic Accident:An Autopsy Case Report[J].Am J Forensic Med Pathol,2020 Oct 7.DOI:10.1097/PAF.0000000000000619.
• [29] MEHTA U M,SHADAKSHARI D,VANI P,et al.Case Report:Obsessive compulsive disorder in posterior cerebellar infarction-illustrating clinical and functional connectivity modulation using MRI-informed transcranial magnetic stimulation[J].Wellcome Open Res,2020,5:189.DOI:10.12688/wellcomeopenres.16183.2.
• [30] ALHAYEK K,ALDABBOUR B,REFA'I H A R,et al.Wernekink Commissure Syndrome:A Rare Cause of Bilateral Cerebellar Syndrome[J].Acta Neurol Taiwan,2020,29(3):86-89.