标准大骨瓣减压术治疗恶性大脑中动脉梗塞的疗效分析

Analysis of Standard Hemicraniectomy the Efficacy of the Treatment of Malignant Middle Cerebral Artery Infarction

目的:探讨标准大骨瓣减压术治疗恶性大脑中动脉梗塞(mMCAI)的疗效。方法:回顾性分析我院神经中心收治的61例mMCAI住院患者临床资料。61例患者分为手术组34例及单纯标准药物治疗组27例,比较两组患者在院及离院1年内的死亡率,离院时及离院1年后神经功能良好率。分析两种治疗方案在治疗mMCAI中的优劣及年龄、手术时间、优势半球病变对手术患者术后死亡率及术后神经功能转归的影响。结果:标准大骨瓣减压术可以有效的降低mMCAI患者的死亡率(P<0.001),但无法改变患者较为严重的神经功能缺失;早期手术可以进一步提高mMCAI患者的生存率(P<0.05);优势半球病变与患者的死亡率及神经功能改善与否无关(P>0.05)。结论:单纯药物治疗对于mMCAI的效果是极其有限的,标准大骨瓣减压术可以有效地提高患者的生存率,降低病残率,尤其对于年轻的患者,早期手术远期效果较好。

Objective： Explore a standard hemicraniectomy the efficacy of the treatment of malignant middle cerebral artery occlusion（mMCAI）.Methods： A retrospective analysis of the clinical data of the the 61 cases mMCAI hospitalized patients admitted to our hospital nerve center.The 61 patients were divided into operation group of 34 cases and a simple standard drug treatment group of 27 patients,were compared between the two groups of patients one year mortality in hospital and discharged from the hospital and from the hospital after one year neurological improvement rate.The merits and age of the analysis of the two treatment regimens in the treatment of mMCAI dominant hemisphere lesions on operative time of surgery in patients with postoperative mortality and postoperative neurologic outcome.Result： Standard hemicraniectomy can reduce mMCAI patients mortality（P0.001）,but can not change in patients with more severe neurological deficits;early surgery can further improve the survival rate of patients with mMCAI（P0.05）;advantagehemisphere lesions and mortality in patients with neurological improvement or not has nothing to do（P0.05）.Conclusion： Simple drug treatment the effect mMCAI is extremely limited,standard hemicraniectomy can effectively improve the survival rate,reduce morbidity,especially for young patients with good long-term effect.