Association between cerebral blood flow diversion and prognosis in patients with acute large hemispheric infarction / 中国医师进修杂志

ABSTRACT

Objective:To analyze the relationship between cerebral blood flow diversion and prognosis of patients with acute large hemispheric infarction (LHI) caused by middle cerebral artery (MCA) M1 segment occlusion.Methods:From May 2015 to May 2018, 182 patients with acute LHI caused by MCA M1 segment occlusion in Ankang Central Hospital were selected. All patients underwent cranial Doppler examination at the early stage of admission. They were divided into flow diversion group (69 cases) and non-flow diversion group (113 cases) according to the condition of cerebral blood flow diversion. The hospital mortality, prognosis at 3, 6 and 12 months after onset in the two groups were analyzed statistically.Results:Compared with those in flow diversion group, the incidence of midline shift[41.6%(47/113) vs. 15.9%(11/69)], mechanical ventilation [32.7%(37/113) vs. 8.7%(6/69)], hospital death [26.5%(30/113) vs. 8.7%(6/69)] and adverse outcomes of 3 months [94.7%(107/113) vs. 66.7% (46/69)], 6 months [72.6%(82/113) vs. 46.4%(32/69)], 12 months [72.6%(82/113) vs. 43.5%(30/69)] after onset in non-flow diversion group were increased significantly ( P<0.05). Multivariate analysis indicated cerebral blood flow diversion was a risk factor for midline shift ( OR=28.721, 95% CI 1.933-35.807), mechanical ventilation ( OR=11.162, 95% CI 1.625-17.029), and poor outcomes at 3 months of onset ( OR=20.052, 95% CI 3.059-23.375), 6 months of onset ( OR=3.536, 95% CI 1.164-10.784) and 12 months of onset ( OR=4.412, 95% CI 1.398-13.971) ( P<0.05). Conclusions:The short-term and long-term prognosis of patients with acute LHI caused by MCA M1 segment occlusion can be predicted by the presence of cerebral blood flow diversion in transcranial Doppler examination of the early stage.