减压颅骨切除术对COVID-19合并恶性梗死患者生存和功能结局的影响:回顾性队列研究和文献综述

Pachipala Sudheer, S. Gomathy, Ayush Agarwal, V. Vishnu, A. Pandit, Vibha Deepti, R. Bhatia, P. Srivastava
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引用次数: 1

摘要

背景与目的在新型冠状病毒感染的多种神经系统表现中,卒中是常见的并发症之一。很大一部分患者有大血管闭塞(LVO),这增加了恶性脑梗死的风险,需要进行减压颅骨切除术。然而,COVID-19对减压颅骨切除术的影响尚未得到很好的描述。通过本研究,我们旨在研究在我们三级医院就诊的COVID-19患者行减压颅骨切除术的影响。材料与方法收集研究期间所有急性缺血性脑卒中COVID阳性患者的资料。其中纳入需要行颅骨减压切除术的患者。记录与脑卒中相关的人口学、临床放射学参数、接受的治疗、结果和并发症。此外,收集并系统回顾了所有已发表的COVID-19缺血性卒中患者行减压颅骨切除术的病例报告和病例系列数据。结果27例脑卒中患者COVID-19感染阳性,其中5例因神经功能恶化行减压半骨切除术。文献综述产生了453篇摘要。在阅读了69篇文章的全文后,最终有12项研究15例患者符合我们的纳入标准,并被纳入系统评价。COVID-19患者中需要开颅减压术的脑卒中患者死亡率为40%。该队列的死亡率和功能结局与大流行前时期相当。结论新型冠状病毒肺炎合并恶性梗死患者与前冠状病毒肺炎患者类似,颅脑减压切除术是一种挽救生命的手术。
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Effect of Decompression Craniectomy on Survival and Functional Outcome in Patients with COVID-19 and Malignant Infarct: A Retrospective Cohort Study and Review of Literature
Background and objective Amongst the varied neurological manifestations of COVID-19 infection, stroke is one of the common complications. A large portion of patients had large vessel occlusion (LVO) which increases the risk of malignant cerebral infarction requiring decompressive craniectomy. The impact of COVID-19, however, on decompressive craniectomy is not well described. Through this study, we aim to study the impact of decompressive craniectomy in COVID-19 patients presented to our tertiary care hospital. Material and methods Data of all acute ischemic stroke patients who tested COVID positive during the study period was collected. From among them, patients requiring decompressive craniectomy were included. The demographic, clinico-radiological parameters related to stroke, treatment received, outcome and complications were noted. In addition, data from all case reports and case series published on patients with COVID-19, who had developed ischemic stroke and underwent decompression craniectomy was collected and systematically reviewed. Results Twenty-seven stroke patients tested positive for COVID-19 infection, out of whom five patients underwent decompression hemicraniectomy in view of neurologic deterioration. The review of literature yielded 453 abstracts. After reading the full text of 69 articles, 12 studies on 15 patients finally met our inclusion criteria and were included in the systematic review. The mortality rate was 40% among stroke patients requiring decompressive craniectomy in COVID-19 patients. The mortality rate and functional outcomes of this cohort are comparable to the pre-pandemic period. Conclusion Decompressive craniectomy is a life-saving procedure in COVID-19 patients with malignant infarctions similar to patients in the pre-COVID-19 era.
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