标准大骨瓣开颅术治疗大面积脑梗塞的临床研究

Clinical Study on Operation of Massive Cerebral Infarction with Standard Large Craniotomy

目的探讨标准大骨瓣开颅(standard large craniotomy)去大骨瓣减压术与常规大骨瓣开颅去大骨瓣减压术对大面积脑梗塞的治疗效果。方法将60例大面积脑梗塞患者(脑梗塞面积>4cm)随机分成研究组(标准大骨瓣开颅)和对照组(常规大骨瓣开颅),在治疗前后对全部患者均进行GCS评分、头颅CT检查并测量脑梗塞灶范围和中线结构移位,TCD监测脑血流情况。根据两组的治疗结果比较其疗效。结果术后7d研究组较对照组的GCS评分、脑梗塞范围和中线结构移位有显著性差异(P<0.05);脑血流明显改善。14d后研究组的各项指标接近正常。研究组死亡率为3.33%,对照组为16.6%。结论标准大骨瓣开颅去大骨瓣减压术治疗大面积脑梗塞伴天幕裂孔疝能减少并发症,降低死亡率,是手术治疗大面积脑梗塞的有效方法。

Objective To investigate and compare the therapeutic effect between using the standard large craniotomy and conventional large craniotomy in the treatment of massive cerebral infarction.Methods 60 cases of massive cerebral infarction（cerebral infarct size4cm） were randomly divided into study group（treated with standard large craniotomy）and control group（treated with conventional large craniotomy）.All patients were given glasgow coma scale（GCS）,head CT of cerebral infarct size and midline shift range and transcranial doppler system（TCD） monitor cerebral blood flow.Efficacy was compared according to the treatment outcome.Results 7 days after the surgery,the glasgow coma scale,cerebral infarct size,midline shift range,cerebral blood flow（CBF） of the study group were significantly improved（P〈0.05）.After 14 days,the indicators for the study group were close to the normal values.Mortality rate for the study group was 3.33% whereas the mortality rate of the control group was 16.6%.Conclusion Standard large craniotomy can reduce complications and mortality rate in surgical treatment of massive cerebral infarction in an effective manner.