颅内压相关参数在急性缺血性脑卒中患者中的应用及对实施去骨瓣减压术的预测研究

Application of intracranial pressure-related parameters in patients with acute ischemic stroke and predictive research for decompressive craniectomy implementation

摘要:

目的 分析颅内压相关参数在急性缺血性脑卒中患者中的应用价值并探讨其对患者实施去骨瓣减压术的预测价值。方法 选取2021年6月—2023年3月河南省人民医院神经外科重症监护病房收治的急性缺血性脑卒中患者，给予24 h持续动态颅内压相关参数监测5～7 d，并根据第1天的脑灌注压（CPP）平均值将患者分为低灌注组（CPP< 60 mmHg），中灌注组（CPP 60～70 mmHg），高灌注组（CPP> 70 mmHg），根据患者是否实施去骨瓣减压术分为实施组和未实施组。比较不同CPP组患者的临床资料，分析患者颅内压相关参数与CPP的相关性；采用多因素逐步Logistic回归分析筛选急性缺血性脑卒中患者实施去骨瓣减压术的独立影响因素，受试者工作特征（ROC）曲线分析颅内压相关参数对急性缺血性卒中患者实施去骨瓣减压术的预测价值。结果 48例急性缺血性脑卒中患者中CPP低灌注组9例（18.8%），CPP中灌注组14例（29.2%），CPP高灌注组25例（52.1%）。3组患者入院格拉斯哥昏迷评分法（GCS）评分、颅内压（ICP）、压力反应指数（PRx）、平均颅内压波幅（MWA）、压力波幅相关性指数（RAP）、动脉压波幅相关系数（IAAC）水平比较，差异均有统计学意义（P <0.05）；Pearson相关性分析显示CPP与PRx（r =-0.662）、MWA（r =-0.867）、RAP（r =-0.789）和IAAC（r =-0.531）呈负相关（P <0.05）。多因素逐步Logistic回归分析结果表明PRx ［O^R =19.076（95% CI：1.495，52.862）］、RAP［O^R =23.352（95% CI：5.443，64.837）］是急性缺血性脑卒中患者实施去骨瓣减压术的危险因素（P <0.05）。结论 颅内压相关参数PRx、MWA、RAP、IAAC与CPP呈负相关，均可以作为急性缺血性脑卒中患者实施去骨瓣减压术的预测因子，为临床调整治疗决策提供依据，从而改善患者预后。

Abstract:

Objective To analyze the application value of intracranial pressure-related parameters in patients with acute ischemic stroke and explore their predictive value for the implementation of decompressive craniectomy.Methods Acute ischemic stroke patients admitted to the Neurosurgery Intensive Care Unit of Henan Provincial People's Hospital from June 2021 to March 2023 were selected. Continuous monitoring of intracranial pressure-related parameters was conducted for 24 hours for 5 to 7 days. Patients were divided into low perfusion group (CPP < 60 mmHg), medium perfusion group (CPP 60 to 70 mmHg), and high perfusion group (CPP > 70 mmHg) based on the average cerebral perfusion pressure (CPP) on the first day. The patients were also categorized into the implementation group and the non-implementation group based on whether decompressive craniectomy was performed. Clinical data of patients with different CPP values were compared. The correlation between intracranial pressure-related parameters and CPP was analyzed. Multifactorial logistic stepwise regression analysis was used to screen independent influencing factors for the implementation of decompressive craniectomy in patients with acute ischemic stroke. Receiver Operating Characteristic (ROC) curve analysis was performed to assess the predictive value of intracranial pressure-related parameters for the implementation of decompressive craniectomy.Results Among 48 patients with acute ischemic stroke, there were 9 cases (18.8%) in the low CPP group, 14 cases (29.2%) in the medium CPP group, and 25 cases (52.1%) in the high CPP group. The GCS score, intracranial pressure (ICP), pressure reactivity index (PRx), mean wave amplitude (MWA), wave amplitude correlation index (RAP), and index of arterial pressure waveform amplitude correlation (IAAC) levels were significantly different among the three groups (P < 0.05). Pearson correlation analysis showed a negative correlation between CPP and intracranial pressure-related parameters including PRx (r = -0.662), MWA (r = -0.867), RAP (r = -0.789), and IAAC (r = -0.531) (P < 0.05). The results of multifactorial logistic stepwise regression analysis indicated that PRx [O^R =19.076 (95% CI: 1.495, 52.862) ] and RAP [O^R =23.352 (95% CI: 5.443, 64.837) ] were risk factors for the implementation of decompressive craniectomy in patients with acute ischemic stroke (P < 0.05).Conclusion Intracranial pressure-related parameters including PRx, MWA, RAP, and IAAC are negatively correlated with CPP and can serve as predictive factors for the implementation of decompressive craniectomy in patients with acute ischemic stroke. This provides a basis for adjusting clinical treatment decisions and improving patient outcomes.