标准大骨瓣减压术治疗大面积脑梗死的临床研究

Clinical analysis of massive cerebral infarction treated by standard large trauma craniotomy

目的探讨标准大骨瓣减压手术治疗大面积脑梗死的临床特点及疗效。方法本院2005年9月至2009年7月收治大面积脑梗死患者50例。其中保守治疗组24例,行传统脱水、营养神经及高压氧等治疗;手术治疗组26例,均行标准大骨瓣减压术,对临床资料进行分析。结果随访1～5年,根据格拉斯哥预后评分(GOS)。保守治疗24例患者恢复良好(GOS5分)4例(16.7%),中残(GOS4分)6例(25%),重残(GOS2～3分)4例(16.7%),死亡(GOS1分)10例(41.7%);手术治疗26例患者恢复良好10例(38.5%),中残7例(26.9%),重残3例(11.5%),死亡6例(23.1%)。两组比较有显著性差异(P<0.05)。结论急性脑疝是大面积脑梗死患者早期死亡主要原因,标准大骨瓣减压术可明显降低大面积脑梗死患者死亡率,术后并发症的防治和早期康复治疗是提高大面积脑梗死患者生存质量的重要因素。

Objective To analyze the clinical features and therapeutic effects of standard large trauma craniotomy in treatment of patients with massive cerebral infarction. Methods A total of 60 patients with massive cerebral infarction diagnosed from September 2005 to July 2009 in our hospital were retrospectively analyzed. 24 cases were treated conservatively with medicine. 26 cases were treated with standard large trauma craniotomy. The clinical features and treatment effects were described and analyzed. Results The follow-up time was 1-5 years. The prognosis was evaluated with Glasgow outcome scale （GOS）. In 24 cases of the conservative group, there were 4 （16.7%） cases with good recovery （GOS 5）, 6 （25%） with moderate disability （GOS 4）, 4 （16.7%） with severe disability or persistent vegetative state （COS 2-3） and 10 （41.7%） deaths （GOS 1）. In 26 cases of the surgery group, there were l0 （38.5%） cases with good recovery, 7 （26.9%） with moderate disability, 3 （11.5%） with severe disability or persistent vegetative state and 6 （23.1%） deaths. There was significant difference between two groups （P〈0.05）, Conclusion Acute brain hernia is the primary cause of early death in massive cerebral infarction patients. Decompressive craniectomy can reduce the mortality of massive cerebral infarction obviously. Management of postoperative complications and early rehabilitation are important for the life quality of the patients.