Risk factors of delayed cerebral hyperperfusion syndrome following decompressive hemicraniectomy for massive cerebral infarction

doi:10.3877/cma.j.issn.1674-6880.2022.02.004

Abstract

Abstract:

Objective

To investigate the clinical characteristics and risk factors of delayed cerebral hyperperfusion syndrome (dCHS) after decompressive hemicraniectomy (DHC) for massive cerebral infarction (MCI).

Methods

A retrospective analysis of 44 patients with MCI who underwent DHC at Ningbo Medical Center Lihuili Hospital from June 2016 to September 2020 was performed. The patients were divided into three groups: dCHS group (n = 10), acute cerebral hyperperfusion syndrome (aCHS) group (n = 14) and non-CHS group (n = 20), based on whether CHS occurred and when it occurred. The general data of the three groups were compared, and the risk factors related to dCHS were analyzed by multivariate Logistic regression.

Results

There were significant differences in middle cerebral artery (MCA) occlusion, hemorrhagic transformation, and reoperation after hemorrhagic transformation among these three groups (χ² = 17.720, 24.144, 18.324, all P < 0.05). The results of multivariate Logistic regression analysis showed that delayed recanalization after MCA occlusion [odds ratio (OR) = 16.750, 95% confidence interval (CI) (1.111, 252.468), P = 0.042] and hemorrhagic transformation [OR = 10.206, 95%CI (1.095, 95.123), P = 0.041] were independent risk factors for the occurrence of dCHS.

Conclusion

Delayed recanalization after MCA occlusion and hemorrhagic transformation are independent risk factors for dCHS in patients with MCI undergoing DHC.

Key words: Massive cerebral infarction, Decompressive hemicraniectomy, Delayed cerebral hyperperfusion syndrome, Acute cerebral hyperperfusion syndrome, Futile recanalization

Jia Li, Gang Shen, Guangyao Zhu, Maosong Chen, Boding Wang. Risk factors of delayed cerebral hyperperfusion syndrome following decompressive hemicraniectomy for massive cerebral infarction[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(02): 111-117.

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References 32

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组别	例数	性别（例，男/女）	年龄（岁）	DHC时间（h）	mRS评分（分）	入院时间（h）	NIHSS评分（分，± s）	GCS评分（分）	收缩压（mmHg，± s）
dCHS组	10	7/3	60.00（25.50，74.00）	45.00（23.25，52.50）	3.00（2.00，5.25）	15.00（5.25，24.00）	16 ± 6	10.00（8.00，13.00）	159 ± 25
aCHS组	14	10/4	73.50（59.75，78.25）	28.00（17.75，76.00）	4.50（2.75，5.00）	19.50（5.75，75.00）	13 ± 6	11.00（6.75，14.00）	151 ± 27
无CHS组	20	14/6	62.50（56.25，70.00）	39.50（27.25，57.50）	5.00（3.00，6.00）	20.00（8.50，42.25）	16 ± 8	10.00（6.00，14.00）	144 ± 28
F/χ²/Z值		0.009	3.730	0.284	2.297	0.698	0.906	0.156	1.007
P值		0.995	0.155	0.868	0.317	0.705	0.412	0.925	0.374
组别	例数	舒张压（mmHg）	体温（℃）	血糖（mmol/L）	红细胞压积（%）	血小板计数（×10⁹/L）	凝血酶原时间（s）	总胆固醇（mmol/L）	高血压（例）
dCHS组	10	85 ± 16	37.60（36.80，38.03）	7.65（6.38，9.83）	41 ± 4	192.50（162.75，238.25）	11.80（11.13，12.33）	3.8 ± 1.5	8
aCHS组	14	86 ± 12	37.15（36.78，37.35）	10.22（7.58，12.01）	38 ± 6	176.50（135.50，219.75）	12.45（11.68，13.40）	4.0 ± 1.1	9
无CHS组	20	81 ± 13	37.60（36.80，37.60）	7.16（6.14，8.71）	39 ± 7	184.00（144.00，229.75）	12.45（11.70，13.85）	4.2 ± 1.0	9
F/χ²/Z值		0.677	0.977	3.797	0.833	0.391	4.722	0.456	3.608
P值		0.514	0.614	0.150	0.442	0.822	0.094	0.637	0.165
组别	例数	2型糖尿病（例）	高脂血症（例）	吸烟（例）	心房颤动（例）	MCA闭塞（例）			MCA高密度征（例）	出血转化（例）	出血转化再手术（例）
组别	例数	2型糖尿病（例）	高脂血症（例）	吸烟（例）	心房颤动（例）	6 h内再通	延迟再通	持续梗死	MCA高密度征（例）	出血转化（例）	出血转化再手术（例）
dCHS组	10	3	4	4	5	1	8	1	2	8	2
aCHS组	14	6	6	6	7	6	7	1	4	14	9
无CHS组	20	7	8	10	5	2	6	12	4	4	0
F/χ²/Z值		0.446	0.032	0.325	2.876		17.720		0.399	24.144	18.324
P值		0.800	0.984	0.850	0.237		0.001		0.819	< 0.001	< 0.001

组别	例数	性别（例，男/女）	年龄（岁）	DHC时间（h）	mRS评分（分）	入院时间（h）	NIHSS评分（分，± s）	GCS评分（分）	收缩压（mmHg，± s）
dCHS组	10	7/3	60.00（25.50，74.00）	45.00（23.25，52.50）	3.00（2.00，5.25）	15.00（5.25，24.00）	16 ± 6	10.00（8.00，13.00）	159 ± 25
aCHS组	14	10/4	73.50（59.75，78.25）	28.00（17.75，76.00）	4.50（2.75，5.00）	19.50（5.75，75.00）	13 ± 6	11.00（6.75，14.00）	151 ± 27
无CHS组	20	14/6	62.50（56.25，70.00）	39.50（27.25，57.50）	5.00（3.00，6.00）	20.00（8.50，42.25）	16 ± 8	10.00（6.00，14.00）	144 ± 28
F/χ²/Z值		0.009	3.730	0.284	2.297	0.698	0.906	0.156	1.007
P值		0.995	0.155	0.868	0.317	0.705	0.412	0.925	0.374
组别	例数	舒张压（mmHg）	体温（℃）	血糖（mmol/L）	红细胞压积（%）	血小板计数（×10⁹/L）	凝血酶原时间（s）	总胆固醇（mmol/L）	高血压（例）
dCHS组	10	85 ± 16	37.60（36.80，38.03）	7.65（6.38，9.83）	41 ± 4	192.50（162.75，238.25）	11.80（11.13，12.33）	3.8 ± 1.5	8
aCHS组	14	86 ± 12	37.15（36.78，37.35）	10.22（7.58，12.01）	38 ± 6	176.50（135.50，219.75）	12.45（11.68，13.40）	4.0 ± 1.1	9
无CHS组	20	81 ± 13	37.60（36.80，37.60）	7.16（6.14，8.71）	39 ± 7	184.00（144.00，229.75）	12.45（11.70，13.85）	4.2 ± 1.0	9
F/χ²/Z值		0.677	0.977	3.797	0.833	0.391	4.722	0.456	3.608
P值		0.514	0.614	0.150	0.442	0.822	0.094	0.637	0.165
组别	例数	2型糖尿病（例）	高脂血症（例）	吸烟（例）	心房颤动（例）	MCA闭塞（例）			MCA高密度征（例）	出血转化（例）	出血转化再手术（例）
组别	例数	2型糖尿病（例）	高脂血症（例）	吸烟（例）	心房颤动（例）	6 h内再通	延迟再通	持续梗死	MCA高密度征（例）	出血转化（例）	出血转化再手术（例）
dCHS组	10	3	4	4	5	1	8	1	2	8	2
aCHS组	14	6	6	6	7	6	7	1	4	14	9
无CHS组	20	7	8	10	5	2	6	12	4	4	0
F/χ²/Z值		0.446	0.032	0.325	2.876		17.720		0.399	24.144	18.324
P值		0.800	0.984	0.850	0.237		0.001		0.819	< 0.001	< 0.001

危险因素		回归系数	标准误	Wald值	P值	OR值	95%CI
入院NIHSS评分（分）		0.066	0.082	0.643	0.423	1.068	0.910 ~ 1.254
MCA闭塞
	6 h内再通	2.138	2.022	1.117	0.290	8.480	0.161 ~ 446.399
	延迟再通	2.818	1.384	4.146	0.042	16.750	1.111 ~ 252.468
出血转化		2.323	1.139	4.160	0.041	10.206	1.095 ~ 95.123

危险因素		回归系数	标准误	Wald值	P值	OR值	95%CI
入院NIHSS评分（分）		0.066	0.082	0.643	0.423	1.068	0.910 ~ 1.254
MCA闭塞
	6 h内再通	2.138	2.022	1.117	0.290	8.480	0.161 ~ 446.399
	延迟再通	2.818	1.384	4.146	0.042	16.750	1.111 ~ 252.468
出血转化		2.323	1.139	4.160	0.041	10.206	1.095 ~ 95.123

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[2]	Yumei Wang, Meng Liu. Research progress in predictive factors of malignant cerebral edema after cerebral infarction [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(02): 163-166.

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