关键词: 脑中线结构, 大面积脑梗死, 缺血预适应, 颅内压代偿

Abstract: Objective　To analyze the relationship between midline deviation degree before surgery and the prognosis after decompression for massive cerebral infarction and provide clinical references. Methods　A retrospective case-control study was conducted. According to the inclusion and exclusion criteria, the data of the patients with massive cerebral infarction treated at Hubei No.3 People's Hospital from October 2014 to October 2020 were collected to analyze the risk factors of death after decompressive craniectomy for massive cerebral infarction, and to study the relationship between the preoperative midline deviation degree and short-term death and long-term functional prognosis. SPSS 26.0 was used for the statistical analysis. t and χ² tests and Fisher's exact test were applied. The influencing factors of long-term Barthel index (BI) were analyzed. Multiple linear regression analysis was applied. Results　A total of 77 patients with massive cerebral infarction who underwent standard decompressive craniectomy were collected, and 39 patients were included at last, including 27 males and 12 females who were 39-86 years old, with an average of 58.7. The patients with a preoperative linear structure deviation less than 10 mm had an increased risk of death after decompression as compared with the patients with a preoperative linear structure deviation ≥ 10 mm [odds ratio (OR)=11.48, 95% confidence interval (CI) 1.12-118.14]. The patients whose Glasgow Coma Scale (GCS) score ≤7 had an increased risk of death after decompression as compared with the patients whose GCS score >7 (OR=13.12, 95%CI 1.41-122.43). Preoperative coma, GCS score, and the deviation degree of cerebral linear structure did not affect the long-term BI of the patients who survived after surgery. Age was one of the factors affecting the long-term prognosis of the survived patients after surgery. With the increase of age, the patients' BI decreased. Conclusions　Preoperative cerebral linear structure deviation <10 mm and GCS score ≤7 points are the risk factors of death after decompression for massive cerebral infarction. The preoperative deviation degree of cerebral linear structure does not affect the long-term functional recovery of survived patients after decompression.

Key words: Cerebral linear structure, Massive cerebral infarction, Ischemic preconditioning, Intracranial pressure regulation