去骨瓣减压术治疗大面积脑梗死的短期疗效评价

Decompressive Craniectomy in Treatment of Space-Occupying Massive Hemispheric Infarction: A Short-term Evaluation

目的:评价去骨瓣减压术治疗大面积脑梗死的效果。方法:制定入选和排除标准,统一术式,比较术前、术后不同时期的神经功能变化,并对存活病例进行随访(6个月),评价术后3和6个月时的预后评分(GOS)和BarthelIndex(BI)的变化。结果:按入选标准行去骨瓣减压术26例,术后死亡率为30.8%。术前昏迷评分GCS对决定手术时机有指导作用。共随访14例患者,术后3和6个月GOS分别为3.6±0.8和4.0±0.8,与出院时GOS评分比差异有统计学意义。术后3和6个月BI分别为68.9±29.4和77.5±28.3,其中术后6个月BI>60者占85.7%。结论:对保守治疗无效的大面积脑梗死患者,去骨瓣减压术不仅可作为一种“救命”手术,而且多数存活病例恢复较好。合理选择手术适应证、及时把握手术时机以及充分手术减压可能是影响预后的重要因素。

Aim： To observe the therapeutical efficacy of decompressive craniectomy in treatment of massive cerebral infarction. Methods ： Decompressive craniectomy was performed in patients who were suitable to the surgical indications of current protocol. The changes of functional recovery were assessed 3 and 6 months after surgery. Results ： Decompressive craniectomy was performed in 26 cases with a mortality rate of 30.8%. A follow-up investigation in 14 patients revealed that the GOS increased from 3.6 ± 0.8 to 4.0 ± 0.8 and the BI from 68.9 ± 29.4 to 77.5 ± 28.3 when assessed 3 and 6 months after decompressive surgery. Patients with BI 〉 60 accounted for 85.7% when evaluated 6 months postoperatively. Also, it was demonstrated that preoperative GCS was an indicator in deciding operation schedule. Conclusion ： Decompressive craniectomy could be regarded as a ＂life-saving＂ intervention to some of large cerebral infarction and functional recovery was probably associated with operation timing and standard extended craniectomy.