去骨瓣减压治疗恶性大脑中动脉脑梗死的初步分析(附26例报告)

The preliminary analysis of decompressive craniectomy in treating patients with massive cerebral infarction

目的分析去骨瓣减压治疗恶性大脑中动脉脑梗死的治疗效果、手术适应证及脑梗死体积对预后的影响。方法回顾性分析了2005年5月至2010年12月间南方医院神经外科收治的26例因恶性大脑中动脉脑梗死行去骨瓣减压治疗的患者的病案资料,影像学表现,以随访时的改良Rankin量表(modified RankinScale,mRS)评分评定其疗效。结果经去骨瓣减压治疗后大部分患者术后格拉斯哥昏迷评分(GCS)较术前明显改善(t=2.789,P<0.05),在年龄<60岁和年龄≥60岁的两组患者中其总体预后的差异无统计学意义(掊2=0.038,P>0.05),脑疝之前手术患者总体预后优于脑疝之后手术的患者(掊2=7.741,P<0.05),梗死体积≥250cm3患者总体预后比<250cm3的患者差(掊2=6.880,P<0.05)。结论在出现脑疝之前接受去骨瓣减压手术能提高恶性大脑中动脉脑梗死患者的生存率及生存质量,梗死体积≥250cm3者疗效较差,年龄可能不是手术禁忌证。

Objective To analyze the therapeutic effects, time window for operation and factors influencing prognosis in patients with massive cerebral infarction who underwent decompressive craniectomy. Methods We retrospectively analyzed the clinical data, radiological findings, Glasgow Coma Scale （GCS）, time between symptom onset and operation, the presence or absence of herniation, consciousness level, and modified Rankin Scale （mRS） in 26 patients with massive cerebral infarction who underwent decompressive craniectomy from May 2005 to December 2010. Results Most of the patients had significant increase in GCS after surgery （t = 2.789, P 〈 0.05）. Patients with cerebral herniation had poorer prognosis than those without （Х^2 = 7.741, P 〈 0.05）. There was no significant difference in the prognosis between patients older than 60 years and those younger than 60 （Х^2 = 0.038, P 〉 0.05）. Patients with infarction volume larger than 250 cm3 had poorer prognosis （Х^ 2 = 6.880, P 〈 0.05）. Conclusions The standard deeompressive craniectomy is a life-saving proeedure for massive cerebral infarction. Carefully selection of patients and early operation may improve the survival rate and functional outcome. Age should not to be contraindieation for surgery. Patients with infarction volume larger than 250 cms and those with cerebral herniation may have a poor prognosis.