去骨瓣减压术治疗恶性大脑梗死术后严重心脏不良事件。

Serious cardiac adverse events after decompressive craniectomy for malignant cerebral infarction.

机构信息

Department of Anesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, India.

出版信息

J Neurosurg Anesthesiol. 2011 Jul;23(3):236-40. doi: 10.1097/ANA.0b013e318218fb04.

DOI:10.1097/ANA.0b013e318218fb04

PMID:21546854

Abstract

BACKGROUND

There is a significant association between cardiac dysfunction and ischemic stroke. The serious cardiac adverse events (SCAEs) after decompressive craniectomy for malignant cerebral infarction from ischemic stroke were studied retrospectively.

METHODS

Retrospective data were collected for preexisting cardiac risk factors, baseline clinical measures, and perioperative SCAEs including life-threatening arrhythmias, myocardial ischemia, cardiac failure, and cardiac arrest. The association between perioperative SCAEs and mortality was assessed using the χ(2) test.

RESULTS

Data from 42 patients were analyzed. Mortality occurred in 19 (45.2%) patients. Eleven (57.9% of deaths) suffered mortality because of neurological causes, 7 patients (36.8% of mortality) because of cardiac causes, and 1 because of other causes. Mortality in patients who developed SCAEs was significantly higher than in those without SCAEs [75% mortality with SCAEs vs. 18.2% without SCAEs (P<0.0001)]. The odds ratio for mortality with SCAEs was 13.5 (3.1 to 59.5). There was a significant correlation between the number of SCAEs and mortality (Spearmans ρ=0.738 (P<0.0001).

CONCLUSION

Serious cardiac events are common in the acute period after stroke and decompressive craniectomy, and are important contributors to mortality.

摘要

背景

心脏功能障碍与缺血性中风之间存在显著关联。本研究回顾性分析了因缺血性中风导致恶性大脑梗死而行去骨瓣减压术后的严重心脏不良事件（SCAE）。

方法

回顾性收集了既往心脏危险因素、基线临床指标以及围手术期 SCAE（包括威胁生命的心律失常、心肌缺血、心力衰竭和心脏骤停）等数据。采用卡方检验评估围手术期 SCAE 与死亡率之间的关联。

结果

共分析了 42 例患者的数据。19 例（45.2%）患者死亡。11 例（死亡患者的 57.9%）因神经系统原因死亡，7 例（死亡患者的 36.8%）因心脏原因死亡，1 例因其他原因死亡。发生 SCAE 的患者死亡率明显高于未发生 SCAE 的患者[SCAE 患者死亡率为 75%，无 SCAE 患者死亡率为 18.2%（P<0.0001）]。发生 SCAE 患者的死亡风险比为 13.5（3.1 至 59.5）。SCAE 的数量与死亡率之间存在显著相关性（Spearmans ρ=0.738，P<0.0001）。