偏侧颅骨切除术治疗大面积脑梗死时机的分析

Opportunity of hemilateral craniotomy in treatment of a large area cerebral infarction

目的探讨偏侧颅骨切除术治疗大面积大脑中动脉梗死手术时机对患者预后的影响。方法32例大面积大脑中动脉梗死患者采用偏侧颅骨切除术，18例于脑疝出现前施术（脑疝前手术组），14例经影像学检查证实脑疝后施术（脑疝后手术组），比较两组患者的病死率、术后3个月的功能转归情况。结果脑疝前手术组病死率16,7％，术后3个月Barthel指数（66．94±17．75）分，优于脑疝后手术组的57．1％和（38．43±9．82）分，差异有统计学意义（P〈0．05或〈0．01）。结论脑疝前施行偏侧颅骨切除术可降低大面积大脑中动脉梗死患者的病死率，改善预后。

Objective To discuss the opportunity of hemilateral craniotomy in treatment of a large area combined middle cerebral artery （MCA） infarction. Methods Thirty-two patients with a large area combined MCA infarction were performed by hemilateral craniotomy. Initial clinical presentation was evaluated by the Glasgow coma scale （GCS）. All surviyors were assessed three months after surgical decompression according to Barethel index（BI）. The effects of pre-hernia decompressive surgery（before any signs of cerebral hernia, based on clinical status and CT or DWI findings）versus post-herniasurgery （after signs of hernia） on mortality, functional outcome. Results In 18 patients with pre-hernia decompressive surgery, 3 patients （16.7%）were dead and average BI was （66.94± 17.75）scores. The mortality was 57.1%（8/14）and average BI was （38.43 ± 9.82）scores of post-hernia surgery with 3 cases severe aphasia. Conclusion Hemilateral craniotomy is performed before occurrence of cerebral hernia may decrease the mortahty and improve outcome in these patients.