| 张建梅,彭湘晖,刘运昌,罗婉莹,黄光仪,杨旭日.PC-MRI技术分析Chiari畸形Ⅰ型患者手术前后脑脊液流体力学的变化及术后颅内感染的影响因素分析[J].,2023,(13):2523-2527 |
| PC-MRI技术分析Chiari畸形Ⅰ型患者手术前后脑脊液流体力学的变化及术后颅内感染的影响因素分析 |
| PC-MRI Technology Analysis of Cerebrospinal Fluid Hydrodynamics in Patients with Chiari Malformation Type I before and after Surgery and Analysis of Influencing Factors of Postoperative Intracranial Infection |
| 投稿时间：2023-02-04 修订日期：2023-02-26 |
| DOI：10.13241/j.cnki.pmb.2023.13.024 |
| 中文关键词: PC-MRI Chiari畸形Ⅰ型 脑脊液流体力学 颅内感染 影响因素 |
| 英文关键词: C-MRI Chiari malformation type Ⅰ Cerebrospinal fluid hydrodynamics Intracranial infection Influencing factors |
| 基金项目:广西壮族自治区卫生健康委员会自筹经费科研项目（Z20201483）；广西壮族自治区南溪山医院院级科研课题（NY2019004） |
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| 中文摘要: |
| 摘要 目的：探究相位对比电影－磁共振成像（PC-MRI）技术分析小脑扁桃体下疝（Chiari）畸形Ⅰ型患者手术前后脑脊液流体力学的变化及术后颅内感染的影响因素。方法：本研究选取本院2019年1月-2022年1月接诊的80例Chiari畸形I型患者展开研究；对所有患者头颈行MRI和PC-MRI 检查，使用Q-flow软件进行脑脊液流体力学分析。对比Chiari畸形I型患者手术前后脑脊液流体力学指标；分析Chiari畸形Ⅰ型患者中术后颅内感染者和未发生颅内感染者的临床特征差异；多因素Logistic回归分析影响Chiari畸形Ⅰ型患者术后发生颅内感染的影响因素。结果：术后3个月，Chiari畸形I型患者中脑导水管平均流量（MF）、每搏输出量（SV）和反流分数（RF）均明显高于术前24 h，足向最大峰值流速（Vdmax）和头向最大峰值流速（Vumax）明显低于术前24 h（P＜0.05）；术后3个月，Chiari畸形I型患者脑桥腹侧MF和SV均明显高于术前24 h，RF、Vdmax和Vumax均明显低于术前24 h（P＜0.05）；术后3个月，Chiari畸形I型患者C3腹侧MF和SV均明显高于术前24 h，RF、Vdmax和Vumax均明显低于术前24 h（P＜0.05）；Chiari畸形Ⅰ型患者中术后发生颅内感染者有19例，未发生感染者有61例；多因素Logistic回归分析结果显示年龄较大、手术时间较长、抗生素未使用和术后脑脊漏液是Chiari畸形Ⅰ型患者术后发生颅内感染的危险因素（P＜0.05）。结论：对于Chiari畸形Ⅰ型患者而言，对其行PC-MRI分析，可将其手术前后脑脊液流体力学进行检测，检测效果较优；Chiari畸形Ⅰ型患者术后发生颅内感染的危险因素包括年龄较大、手术时间较长、抗生素未使用和术后脑脊漏液。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the phase-contrast magnetic resonance image (PC-MRI) technology analysis the changes of cerebrospinal fluid hydrodynamics before and after surgery in patients with subtonsillar hernia (Chiari) malformation type I and the influencing factors of postoperative intracranial infection. Methods: In this study, 80 patients with Chiari malformation type I who were admitted to our hospital from January 2019 to January 2022 were selected for study. MRI and PC-MRI examinations were performed on the head and neck of all patients, and cerebrospinal fluid hydrodynamics were analyzed using Q-flow software. The cerebrospinal fluid hydrodynamics indexes of patients with Chiari malformation type I were compared before and after surgery. The difference of clinical features between postoperative intracranial infection and non-intracranial infection in patients with Chiari malformation type Ⅰwere analyzed. Multivariate Logistic regression analysis of the influencing factors of postoperative intracranial infection in patients with Chiari malformation type I. Results: 3 months after surgery, the mean flux (MF), stroke volume (SV) and regurgitant fraction (RF) in the patients with Chiari malformation type I were significantly higher than those at 24 h before surgery, and the maximum peak velocity of foot (Vdmax) and maximum peak velocity of head (Vumax) were significantly lower than those at 24 h before surgery(P<0.05). 3 months after surgery, the ventral pons MF and SV in the patients with Chiari malformation type I were significantly higher than those at 24 h before surgery, and RF, Vdmax and Vumax were significantly lower than those at 24 h before surgery(P<0.05). 3 months after surgery, ventral MF and SV of C3 and RF, Vdmax and Vumax in the patients with Chiari malformation type I were significantly higher than those at 24 h before surgery(P<0.05). Among the patients with Chiari malformation type I, there were 19 cases with intracranial infection after surgery, and 61 cases without infection. Multivariate Logistic regression analysis showed that older age, longer operation time, no use of antibiotics and postoperative spinal fluid leakage were risk factors for postoperative intracranial infection in patients with Chiari malformation type I(P<0.05). Conclusion: PC-MRI can effectively analyze the changes of cerebrospinal fluid hydrodynamics in patients with Chiari malformation type I before and after surgery. Risk factors for postoperative intracranial infection in patients with Chiari malformation type I include older age, longer operation time, no use of antibiotics, and postoperative spinal fluid leakage. |
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