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

摘要： 目的　分析术前中线偏移程度与大面积脑梗死减压术后预后的关系，以供临床参考。方法　采用回顾性病例对照研究，根据入选标准与排除标准，选取2014年10月至2020年10月湖北省第三人民医院收治的行去骨瓣减压术的患者资料，分析大面积脑梗死患者行去骨瓣减压术后死亡的危险因素，并研究术前中线偏移程度与近期死亡及远期功能预后的关系。应用SPSS 26.0软件包进行统计分析，采用t、χ²检验或Fisher确切概率法。对术后死亡的可能危险因素先进行单因素分析，对差异显著的因素再进行二分类的logistic回归分析；对远期Barthel 指数（BI）的影响因素分析，采用多元线性回归分析。结果　共收集行标准去骨瓣减压术的大面积脑梗死病例77例，最终入选符合要求者39例，其中男27例、女12例，年龄39～86岁、平均年龄58.7岁。术前中线偏移小于10 mm相对于大于等于10 mm者，去骨瓣减压术后的死亡风险增加［比值比（OR）=11.48，95%置信区间（CI）：1.12～118.14）］；格拉斯哥昏迷量表（GCS）评分≤7分相对于GCS评分>7分者，去骨瓣减压术后的死亡风险增加（OR=13.12，95%CI：1.41～122.43）。术前昏迷、GCS评分与中线移位程度均不影响术后存活患者的远期BI。年龄是影响存活患者术后远期预后的因素之一，随着年龄的增大，患者的远期BI呈下降趋势。结论　术前中线偏移<10 mm与GCS评分≤7分是大面积脑梗死行去骨瓣减压术后死亡的危险因素；术前中线的偏移程度并不影响术后存活患者的远期功能恢复。

关键词: 脑中线结构, 大面积脑梗死, 缺血预适应, 颅内压代偿