早期去骨瓣减压术治疗大面积脑梗死36例临床分析

Clinic Analysis of 36 Patients with Massive Brain Infarction Treated by Decompressive Craniotomy in the Early Stage

目的:比较早期实施去骨瓣减压术和内科药物治疗大面积脑梗死的疗效,以探讨大面积脑梗死的正确治疗方法,减少死亡率和提高患者的生存质量。方法:对2005年8月至2012年8月收治的大面积脑梗死患者76例采用去骨瓣减压术治疗36例(外科组)和采用内科药物治疗40例(内科组),比较两组患者的死亡率和康复情况,并探讨影响患者手术治疗效果的相关因素。结果:手术组的死亡率明显低于内科组,康复情况明显优于内科组,P均<0.05。术前脑组织中线偏移≥10 mm者,术后预后不良;48 h内手术者较48 h后的预后好。结论:早期去骨瓣减压术治疗大面积脑梗死较单纯内科保守治疗可降低其死亡率和提高其生存质量。

Objective： To compare the clinical effect of the decompressive craniotomy and the medical treatment for massive brain infarction in the early stage, and to explore the treatment methods for patients with massive brain infarction in order to reduce the mortality and to improve the life quality. Method： 76 patients with massive brain infarction admitted in our hospital from Aug 2005 to Aug 2008 were divided into 2 groups,the surgical group（n=36） were treated by decompressive craniotomy and the medical group （n=40） were treated by medical drugs. The mortality and the rehabilitation level were compared between the two groups. The factors influencing the prognosis in the surgical group were analyzed. Results：Compared to the medical group, the surgical ~group ：indicated the lower mortality and the higher rehabilitation level （both P 〈 0.05）. Moreover, patients with brain midline shift ≥ 10mm before the surgery had a poor prognosis, and the prognosis of those who accepted surgery within 48 h were better than those had the surgery after 48 h. Conclusion： Compared to the single medical treatment, the decompressive craniotomy in the early stage could reduce the mortality and improve the life quality for patients with tiae massive brain infarction.