Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care
Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care
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DOI：
10.1007/s001340050625
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发表时间：
1998-06-01
影响因子：
38.9
通讯作者：
Schneider, D
中科院分区：
文献类型：
--
作者：
Berrouschot, J;Sterker, M;Schneider, D
目的：了解在最大程度的保守重症监护下，占位性（“恶性”）大脑中动脉（MCA）梗塞的死亡率是多少。确定是否存在任何早期生存指标。设计：前瞻性描述性研究。地点：大学医院的神经重症监护病房。患者：53 名患有“恶性”MCA 梗塞的患者（平均年龄 64 +/- 10 岁）。干预措施：使用标准化方案（肝素、渗透疗法氨丁三醇、轻度过度通气）进行最大限度的保守重症监护。症状出现后12小时内开始治疗。测量和结果：每天记录格拉斯哥昏迷量表（GCS）和斯堪的纳维亚卒中量表（SSS）。入院时、第3天和第7天进行计算机断层扫描（CT）扫描。3个月后记录存活患者的SSS、Barthel指数和Rankin量表。入院时，平均 GCS 为 13 +/- 3 分，平均 SSS 为 18 +/- 7 分。所有患者都必须接受机械通气（症状出现后 23 +/- 26 小时），并在 28 +/- 30 小时后昏迷。在 53 名患者中，平均 90 +/- 59 小时后，37 名 (70%) 患者在重症监护病房 (ICU) 中脑死亡。 3 个月后，42/53 (79%) 患者死亡。幸存患者的 Barthel 指数为 54 +/- 12 分，SSS 25 +/- 9 分，Rankin 量表 3 F1 分。死亡患者入院时的体温明显高于幸存患者（36.5 摄氏度 vs 36.3 摄氏度）。结论：尽管采取了最大限度的保守重症监护，“恶性”MCA 梗塞患者的死亡率仍然非常高。
Objective: To find what the mortality rate of space-occupying ('malignant') middle cerebral artery (MCA) infarction is under maximum conservative intensive care. To establish whether any early indicators of survival exist.Design: Prospective descriptive study.Setting: Neuro-critical care unit of a university hospital.Patients: Fifty-three patients (mean age 64 +/- 10 years) with 'malignant' MCA infarction.Interventions: Maximum conservative intensive care using a standardized protocol (heparin, osmotherapy tromethamol, mild hyperventilation). The start of therapy was within 12 h after the onset of symptoms.Measurements and results: The Glasgow Coma Scale (GCS) and Scandinavian Stroke Scale (SSS) were recorded daily A computed tomography (CT) scan was performed on admission, on day 3 and on day 7. SSS, Barthel Index and Rankin Scale of the surviving patients were recorded after 3 months. On admission, the mean GCS was 13 +/- 3 points and mean SSS 18 +/- 7 points. All patients had to undergo mechanical ventilation (23 +/- 26 h after the onset of symptoms) and were comatose after 28 +/- 30 h. Of 53 patients, 37 (70 %) suffered brain death in the intensive care unit (ICU) after an average of 90 +/- 59 h. After 3 months 42/53 (79 %) patients had died. The Barthel Index of the surviving patients was 54 +/- 12 points, the SSS 25 +/- 9 points and the Rankin Scale 3 Fl points. The deceased patients had a significantly higher body temperature on admission than the surviving patients (36.5 degrees C vs 36.3 degrees C).Conclusions: The mortality of patients with 'malignant' MCA infarction is very high despite maximum conservative intensive care.