标准大骨瓣开颅术治疗大面积脑梗死的临床研究

Clinical study on standard large trauma craniotomy for treating a large area of cerebral infarction

目的探讨标准大骨瓣开颅去大骨瓣减压术与大骨瓣开颅去大骨瓣常规减压术对治疗大面积脑梗死的效果。方法将60例大面积脑梗死患者(脑梗死面积>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检查并测量脑梗死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、脑梗死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死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死的有效方法。

Objective To investigate the effects of standard large trauma craniotomy （standard large craniotomy） to go hemicraniectomy craniotomy to large trauma conventional decompression for the treatment of massive cerebral infarction. Methods Totally 60 cases of patients with massive cerebral infarction （infarct area 〉 4cm） were randomly divided into study group （standard craniotomy） and control group （conventional craniotomy）, before and after treatment, all patients were GCS score, cranial CT examination and measurement of cerebral infarction stove range and midline structures shift, TCD monitoring of cerebral blood flow. According to the treatment results of the two groups to compare their efficacy. Re-suits GCS score of 7 d after the study group than that in the control group, cerebral infarction scope and midline shift significant difference （ P 〈 0. 05 ） ; cerebral blood flow was significantly improved. After 14 days of the Study Group of the indicators to be near normal. The study group mortality rate was 3.33%, and 16. 6% in the control group. Conclusions The standard large trauma craniotomy to hemicraniectomy treatment of large cerebral infarction with canopy hiatal hernia can reduce complications and mortality, is an effective method for the surgical treatment of massive cerebral infarction.