Analysis Of Risk Factors Of MCA Cerebral Infarction After Decompressive Craniectomy In TBI Patients

Objective To explore the related risk factors of middle cerebral artery(MCA)cerebral infarction after decompressive craniectomy and to improve the treatment effect of traumatic brain injury(TBI),the clinical features and prognosis of some TBI patients with intracranial hypertension undergoing decompressive craniectomy were reviewed,and its possible clinical pathological mechanism were analyzed.Objects and MethodsThe data of patients of TBI with intracranial hypertension undergoing decompressive craniectomy in the Department of Neurosurgery of the First Affiliated Hospital of Hainan Medical College from January 2012 to December 2019 were collected.According to whether the decompressive craniectomy was combined with MCA cerebral infarction,they were divided into A,Group B.Group A: MCA cerebral infarction occurred after the decompressive craniectomy;Group B: MCA cerebral infarction did not occur after the decompressive craniectomy.The single factor(independent variables)such as the patient’s age,the type of brain contusion and laceration,bleeding site,preoperative and postoperative GCS score,degree of midline deviation,hematoma volume,the annular cistern is compressed,pupil reflection to light,the timing of surgery,ICP value,blood pressure of perioperative period(preoperative,intraoperative and postoperative)were analysed by using chi-square test and t-test for univariate analysis.Logistic regression analysis was used for multivariate analysis.Follow up the postoperative situation of the patients and analyze its influence on the prognosis.ResultsThere were 103 patients of TBI with intracranial hypertension undergoing decompressive craniectomy in this study.Of the 29 patients in group A,16 died(55.2%),8(27.6%)in vegetative state,1 severely disabled(3.4%),moderate 3 cases(10.4%)were disabled and 1 case(3.4%)recovered well.All 5 awake patients were awake within 2 weeks;13 of 16 dead patients died within 2 weeks.There were 74 cases in group B,including 6 deaths(3.4%),13 cases of vegetative survival(17.6%),11 cases of severe disability(14.9%),9 cases of moderate disability(12.2%),and 35 cases of good recovery(47.3%)).Results: preoperative and postoperative GCS,the type of brain contusion and laceration,hematoma volume,the annular cistern is compressed,pupil reflection to light,blood pressure of perioperative period(preoperative,intraoperative and postoperative),ICP value were found statistical significance between Group A and B(P<0.05),and extensive brain contusion and laceration,hematoma volume ≥70ml,preoperative and postoperative GCS≤5,perioperative(preoperative,intraoperative and postoperative)hypotension,the annular cistern is compressed to disappear,loss of pupillary light reflection,and persistent intracranial hypertension as risk factors of those patients with MCA cerebral infarction after decompressive craniectomy in TBI.Another factors such as patient’s age,bleeding site,the timing of surgery,midline deviation,etc.were found non-significance between Group A and B(P>0.05).Multivariate logistic regression analysis found that: time from injury to operation ≥ 6 hours,preoperative and postoperative GCS score ≤ 5 and postoperative hypotension were independent risk factors of patients with MCA cerebral infarction after decompressive craniectomy in TBI.ConclusionPatients with extensive brain contusion and laceration,hematoma volume ≥70ml,preoperative and postoperative GCS≤5,perioperative(preoperative,intraoperative and postoperative)hypotension,the annular cistern is compressed to disappear,loss of pupillary light reflection,and persistent intracranial hypertension were risk factor for MCA cerebral infarction after decompressive craniectomy in TBI.Preoperative and postoperative GCS≤5,time from injury to operation ≥6 hours and postoperative hypotension were independent risk factors for MCA cerebral infarction after decompressive craniectomy in TBI.