不同手术时机行去大骨瓣减压术对大面积脑梗死患者神经功能和预后的影响

Effect of Different Operation Time to Large Bone Flap Decompression on Neurological Function and Prognosis in Patients with Large Area Cerebral Infarction

目的探讨不同手术时机行去大骨瓣减压术对大面积脑梗死患者神经功能和预后的影响。方法选取我院2013年3月~2018年3月收治的大面积脑梗死患者120例。根据患者是否接受手术及手术时间的不同分为早期治疗组(n=42),延迟治疗组(n=38)和保守治疗组(n=40)。保守治疗组接受常规治疗,早期治疗组及延迟治疗组在保守治疗组的基础上行去大骨瓣减压术治疗。治疗14d、6个月后采用美国国立卫生研究院卒中量表(NIHSS)评估患者的神经功能,采用格拉斯哥昏迷量表(GCS)评分评估患者意识障碍,比较患者肢体运动功能障碍和语言障碍恢复情况及生存情况。结果早期治疗组生存率高于延迟治疗组及保守治疗组,差异具有统计学意义(P<0.05);早期治疗组肢体运动功能恢复率和语言功能恢复率均高于延迟治疗组及保守治疗组,差异具有统计学意义(P<0.05);延迟治疗组生存率、肢体运动恢复率和语言功能恢复率均高于保守治疗组,差异具有统计学意义(P<0.05);早期治疗组治疗14d、6个月后NIHSS评分均低于延迟治疗组及保守治疗组,差异具有统计学意义(P<0.05);早期治疗组治疗14d、6个月后GCS评分均高于延迟治疗组及保守治疗组,差异具有统计学意义(P<0.05)。结论大面积脑梗死患者早期行去大骨瓣减压术有助于改善患者神经功能及意识障碍情况,促进肢体运动恢复及语言功能恢复,提高患者生存率。

Objective To investigate the effects of different operation time and large bone flap decompression on the neurological function and prognosis of patients with large area cerebral infarction.Methods 120 patients with large-area cerebral infarction admitted to our hospital from March 2013 to March 2018 were selected.The patients were divided into the early treatment group(n=42),the delayed treatment group(n=38)and the conservative treatment group(n=40)according to whether the patients received surgery and surgery time.The conservative treatment group received conventional treatment,and the early treatment group and the delayed treatment group were treated with large bone flap decompression in the conservative treatment group.After 14 d and 6 months of treatment,the National Institutes of Health Stroke Scale(NIHSS)was used to assess neurological function,and the Glasgow Coma Scale(GCS)score was used to assess the patient's disturbance of consciousness and to compare the recovery of limb motor dysfunction and speech impairment situation and survival.Results The survival rate of the early treatment group was higher than that of the delayed treatment group and the conservative treatment group,the difference was statistically significant(P<0.05).The recovery rate of limb motor function and the recovery rate of language function in the early treatment group were higher than those in the delayed treatment group and the conservative treatment group,the difference was statistically significant(P<0.05).The survival rate,limb recovery rate and language function recovery rate of the delayed treatment group were higher than the conservative treatment group,the difference was statistically significant(P<0.05);the early treatment group was treated for 14 d after 6 months,the NIHSS scores were lower than those in the delayed treatment group and the conservative treatment group,the difference was statistically significant(P<0.05).The GCS scores in the early treatment group were higher than those in the delayed treatment group and the conservative treatment group after 14 d and 6 months,the difference was statistically significant(P<0.05).Conclusion Early decompression of large bone cerebral infarction in patients with large area cerebral infarction can improve the neurological function and disturbance of consciousness,promote the recovery of limb movement and recovery of language function,and improve the survival rate of patients.