摘要目的 探讨经颅多普勒超声(transcranial Doppler,TCD)探测脑血流分流信号对急性大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)的大脑半球大面积梗死(large hemispheric infarction,LHI)患者预后的早期判别价值.方法 基于西京医院神经内科重症监护室神经重症病例前瞻性登记数据库,分析2012年1月至2016年6月所有急性大脑中动脉M1段闭塞的LHI患者的短期及长期预后.所有患者均于入院早期接受TCD检查,根据是否存在脑血流分流(flow diversion,FD)现象将其分为FD+组和FD-组,比较两组患者的院内病死率以及发病3、6、12个月的预后,运用卡普兰-迈耶生存曲线分析比较两组患者的长期生存率,应用受试者工作特征(receiver operatingcharacteristic,ROC)曲线分析FD现象对MCAO LHI患者发病3个月预后的预测价值.结果 最终共73例急性MCAO LHI患者入组,其中45例(61.64％)纳入FD-组,28例(38.36％)纳入FD+组.单因素统计分析发现FD-组的脑疝发生率、机械通气应用率、院内病死率以及3个月、6个月、12个月不良结局发生率[改良Rankin量表(modified Rankin Scale,mRS)评分＞3分]均明显高于FD+组患者.多因素回归分析表明FD现象存在与否是脑疝(OR=28.943,95％CI 1.922～435.918,P=0.0 15)、机械通气应用(OR=1 1.151,95％CI 1.614～77.018,P=0.014)以及患者3个月(OR=20.163,95％CI 3.048～133.362,P=0.002)、6个月(OR=3.525,95％CI.153～10.773,P=0.027)及12个月(OR=4.400,95％CI 1.387～13.960,P=0.012)不良结局的独立危险因素.ROC曲线分析提示存在FD现象可能可以预测MCAOLHI患者发病3个月时的预后情况.结论 脑梗死急性期TCD检测中的FD现象可用于早期判别MCA0LHI患者的预后.

abstractsObjective To examine the prognostic value of flow diversion (FD) presented on transcranial Doppler ultrasound (TCD) in patients with large hemispheric infarction (LHI) caused by the unilateral middle cerebral artery (MAC) occlusion.Methods Seventy-three consecutive LHI patients who had occlusion in M1 segment of MAC and were admitted to neurological intensive care unit at Xijing Hospital from January 2012 to June 2016 were reviewed.All the participants had TCD examination after admission,and were grouped according to the presence or absence of FD into FD+ and FD-.Three-month,six-month,and twelve-month functional outcomes of all the participants were collected and analyzed.Long-term survival rates were compared using Kaplan-Meier survival analysis.Receiver operating characteristic curve (ROC) was used to examine the predictive power of FD in patients with LHI.Results Among 73 LHI patients,28 (38.36％) patients were presented with FD.The incidence rates of cerebral herniation,usage of mechanical ventilation,mortality during hospitalization and incidence rates of three-month,six-month and twelve-month poor outcomes were much higher in patients without FD than those with FD.Multivariate analyses demonstrated that FD was independently associated with cerebral herniation (OR=28.943,95％CI 1.922-435.918,P=0.015),usage of mechanical ventilation (OR=11.151,95％CI 1.614-77.018,P=0.014),three-month (OR=20.163,95％CI 3.048-133.362,P=0.002),six-month (OR=3.525,95％CI 1.153-10.773,P=0.027),and twelve-month (OR=4.400,95％CI 1.387-13.960,P=0.012) poor outcomes.FD yielded an area under the ROC of 0.756,allowing for prediction of three-month outcomes of LHI.Conclusion FD presented on TCD is an early predictor of outcomes in patients with LHI.