惡性中大腦動脈梗塞病人的預後及其影響因素

背景：惡性中大腦動脈梗塞病人具有高機率的不良預後和死亡風險，早期介入有助於增加治療成效，進而提升病人的存活率及生活品質。目的：本文旨在評估惡性中大腦動脈梗塞病人的預後及其影響因素。方法：本研究採用回溯性世代研究法探討惡性中大腦動脈梗塞病人接受治療後的死亡風險及其影響因素，研究對象來自中台灣某區域醫院，執行期間為2008-2012年，主要的不良結果為死亡。統計方法利用Kaplan-Meier test及Cox-regression評估惡性中大腦動脈梗塞病人治療後的一年內死亡風險，統計顯著水準的α值設為0.05。結果：惡性中大腦動脈梗塞的總個案數為95人，病人接受治療後的一年內存活率為64.2%。Cox-regression分析結果顯示：惡性中大腦動脈梗塞病人在接受治療後，一年內的主要死亡風險因子為兩側梗塞(p<0.05)以及大腦中線移位大於10毫米(p<0.05)，去骨瓣減壓術對於降低病人死亡風險的臨床效益未達統計上的顯著水準(p>0.05)，共病症及不良生活習慣的有無，亦與病人的死亡風險無顯著相關性(p>0.05)。結論：惡性中大腦動脈梗塞病人具有高的死亡風險，去骨瓣減壓術是可供選擇的外科治療法，但其臨床效益宜審慎評估。

Background: The patients with malignant middle cerebral artery (MCA) infarction often have a poor prognosis and a high hazard ratio of death. Early interventions can enhance treatment effects on MCA patients and then increase their survival rate and quality of life. Objectives: A retrospective cohort method was introduced into this study. We performed one-year outcome and survival analysis for MCA patients. From 2008 to 2012, the qualified MCA patients were enrolled in this study from a regional hospital of middle Taiwan region. The main indicator of outcome is death. We perform the Kaplan-Meier test and the Cox-regression to evaluate the hazard ratio of death for patients with malignant middle cerebral artery. The duration of follow-up is one year. A significant level of α-value is set at 0.05.Results: In all, there are ninety-five MCA patients in this survey and their one-year survival rate is 64.2%. According to the results by Cox-regression, the significant risk factors of death for these patients include bilateral infarction (p<0.05) and midline shift of the brain more than 10 mm (p<0.05). Decompressive hemicraniectomy, comorbidity, and bad habits present a non-significant correlation. Conclusion: The MCA patients are in high risk of death. Decompressive craniectomy is an alternative surgical therapy, but its clinical benefit should be assessed carefully.