大骨瓣减压手术治疗恶性脑梗死的临床评价

Efficacy of decompressive hemicraniectomy for patients with malignant cerebral infarction

目的：探讨大骨瓣减压手术治疗恶性脑梗死患者的疗效和影响因素。方法选取42例因恶性脑梗死行减压手术的患者，回顾分析患者年龄、入院时及术前格拉斯哥昏迷评分（GCS）、术前瞳孔变化、中线移位程度、起病至手术时间、手术方式与术后格拉斯哥预后评分（GOS）的关系，根据GOS将患者分为预后良好组（GOS 4~5分）与不良组（GOS 1-3分）进行比较。结果 GOS预后良好组18例（42.9%）；预后不良组24例（57.1%），其中死亡7例。两组患者年龄、术前是否出现两侧瞳孔不等大、术前GCS的差异均有统计学意义（均P＜0.05）。结论恶性脑梗死发生后，患者一旦出现意识障碍并进行性加重，应及时手术，尤其是相对年轻的患者；当患者出现深度昏迷（GCS＜8分）、瞳孔不等大时再进行手术，患者预后较差。手术的关键是制作足够大的骨瓣进行充分减压。

Objective To evaluate the clinical efficacy of decompressive hemicraniectomy in patients. Methods Forty two patients with malignant cerebral infarction were treated with decompressive hemicraniectomy. The clinical data including：age, Glasgow Coma Scale （GCS） score on admission and before surgery, anisocoria, degree of midline shift, the time from diag-nosis to surgery, surgical modalities were retrospectively reviewed. Clinical outcomes were assessed by the Glasgow Outcome Scale （GOS）. Results Among 42 patients, 18（42.9%） achieved a good outcome（GOS4- 5） and 24（57.1%） had a poor outcome （GOS1- 3）. Older age, presence of anisocoria before surgery and lower preoperative GCS score were associated with poor out-comes （P〈0.05）. Conclusion Patients with preoperative GCS score less than 8 and anisocoria has poor outcome of malignant cerebral infarction, so decompressive hemicraniectomy should be performed prior to the presence of anisocoria and increased disturbance of consciousness, especial y for younger patients.