标准大骨瓣减压术治疗大面积脑梗死临床体会

Application of standard large craniotomy in management of massive cerebral infarction

目的探讨标准大骨瓣减压术治疗大面积脑梗死两种不同方法的疗效以及影响其疗效的因素。方法对大面积脑梗死患者随机分组部分行标准大骨瓣减压颞肌黏覆术,另一部分行标准大骨瓣减压硬膜扩大减张缝合术,术后分析其疗效,并分析GCS评分和梗死面积同患者疗效的关系。结果35例中是否行颞肌黏覆术对其疗效无明显差别,GCS评分低,梗死面积大的患者疗效差。结论标准大骨瓣减压术是治疗大面积脑梗死的有效方法,硬膜扩大减张缝合术优于颞肌黏覆术,判断大面积脑梗死术后疗效基本因素为患者术前GCS评分和梗死范围。

[Objective] To discuss the two methods in large craniotomy and other effect factors. [Methods] All the massive cerebral infarction patients were d ivided in two groups randomly. One group were treated with standard large cranio tomy and temporal muscle coherece. Another group were treated with standard larg e craniotomy and dural relaxation suture. Analysis the relationship between GCS and cerebral infarction area. [Results] Temporal muscle coherencs had no obvio usly effects in all the 35 patients. The patients had worse outcome with lower G CS and large area of cerebral infarction. [Conclusion] The procedure of the st andard large craniotomy is an effective surgical intervention for the treatment of massive cerebral infarction. Dural relaxtion suture is superior to temporal m uscle coherence. The basic effect factors for outcome are GCS and the area of ce rebral infarction.