去骨瓣减压术治疗老年幕上大面积脑梗死患者（DECAP）：一项前瞻性观察研究。

Decompressive Hemicraniectomy in Elderly Patients With Space-Occupying Infarction (DECAP): A Prospective Observational Study.

机构信息

Department of Neurology, University Hospital, Technische Universität Dresden, Dresden, Germany.

Department of Neurology, Ostalb-Klinikum Aalen, Aalen, Germany.

出版信息

Neurocrit Care. 2019 Aug;31(1):97-106. doi: 10.1007/s12028-018-0660-3.

DOI:10.1007/s12028-018-0660-3

PMID:30569269

Abstract

BACKGROUND

Decompressive hemicraniectomy improves survival rates and functional outcome in patients with space-occupying middle cerebral artery (MCA) infarction. We sought to determine clinical outcomes in elderly patients with MCA infarction treated with hemicraniectomy and to identify factors associated with functional outcome.

METHODS

We performed a prospective, single-center observational study aiming to include patients aged ≥ 61 years with large MCA infarction treated with hemicraniectomy. The primary endpoint was the functional outcome according to modified Rankin Scale (mRS) score at 6 months after hemicraniectomy. Secondary endpoints included outcome measures at 12 months. A pooled analysis of individual patient data from the single-center cohort and a DESTINY 2 trial subgroup was performed to identify factors associated with functional status at 12 months.

RESULTS

We included 40 MCA infarction patients who underwent hemicraniectomy between 2012 and 2017 at our university hospital (median [IQR] patient age 64 [62-67] years, National Institutes of Health Stroke Scale score 17 [16-21]). The dominant hemisphere was affected in 22/40 patients. Hemicraniectomy was performed within 31 [23-53] h of symptom onset. At 6 months after hemicraniectomy, 6/40 patients (15%) were moderately or moderately severely disabled (mRS score 3 or 4), 19 (47.5%) severely disabled (mRS score 5), and 15 (37.5%) had died. Compared to surgically treated DESTINY 2 patients, the single-center patients less likely exhibited favorable functional outcome at 6 months (mRS scores 0-4; odds ratio 0.239 [95% CI 0.082-0.696]). Case-fatality rate at 12 months was 43%. In a pooled analysis including 79 patients from DECAP and DESTINY 2, no significant associations of baseline and treatment factors with the clinical status at 12 months were observed.

CONCLUSIONS

In this single-center cohort of elderly patients with space-occupying MCA infarction and decompressive hemicraniectomy, the probability for survival without severe disability was low. Lethality at 6 and 12 months was comparable to previously reported data from a randomized trial.

摘要

背景

去骨瓣减压术可提高占位性大脑中动脉（MCA）梗死患者的生存率和功能结局。我们旨在确定接受去骨瓣减压术治疗的 MCA 梗死老年患者的临床结局，并确定与功能结局相关的因素。

方法

我们进行了一项前瞻性、单中心观察性研究，旨在纳入年龄≥61 岁、接受去骨瓣减压术治疗的大面积 MCA 梗死患者。主要终点是去骨瓣减压术后 6 个月时改良 Rankin 量表（mRS）评分的功能结局。次要终点包括 12 个月时的结局测量。对单中心队列和 DESTINY 2 试验亚组的个体患者数据进行汇总分析，以确定与 12 个月时功能状态相关的因素。

结果

我们纳入了 2012 年至 2017 年在我们大学医院接受去骨瓣减压术的 40 例 MCA 梗死患者（中位[IQR]患者年龄 64[62-67]岁，国立卫生研究院卒中量表评分 17[16-21]）。40 例患者中有 22 例为优势半球受累。去骨瓣减压术在症状发作后 31[23-53]小时内进行。去骨瓣减压术后 6 个月，40 例患者中有 6 例（15%）中度或重度残疾（mRS 评分 3 或 4），19 例（47.5%）严重残疾（mRS 评分 5），15 例（37.5%）死亡。与手术治疗的 DESTINY 2 患者相比，单中心患者在 6 个月时的功能结局更差（mRS 评分 0-4；比值比 0.239[95%CI 0.082-0.696]）。12 个月时的病死率为 43%。在包括 DECAP 和 DESTINY 2 的 79 例患者的汇总分析中，未观察到基线和治疗因素与 12 个月时临床状态的显著相关性。