去骨瓣减压及颞肌贴敷治疗脑梗死:经验与问题

Decompressive craniectomy and temporal muscle sticking therapy of cerebral infarction: experience and problems

背景:外科手术方法能够缓解大面积脑梗死患者颅内压升高、脑组织肿胀、脑干压迫等病变,解除严重并发症的风险,为内科治疗争取时间,降低致死致残率。目的:探讨去骨瓣减压加颞肌贴敷治疗脑梗死的临床应用价值。方法:回顾性分析37例脑梗死临床资料,其中男24例,女13例;年龄10-55岁。均进行骨瓣减压加颞肌贴敷治疗,术后随访,参考格拉斯哥预后评分,疗效分优、良、中、无变化、差5个标准等级。结果与结论:随访6个月时,37例患者外科治疗总有效率89%,其中优5例(14%),良15例(41%),中13例(35%),无变化4例(11%),无加重者。头颅CT复查脑梗死患者31例,但其中19例患者梗死灶范围明显减小,尤其是皮质重新密度深,生活能自理12例的脑皮质恢复活性。术后随访1年,31例患者获得随访结果,剩余6例因联系方式失效而失访。23例远期疗效满意,能从事一般工作和简单劳动,2例发生对侧脑梗死,病情加重。表明去骨瓣减压联合颞肌贴敷可作为治疗大部分脑梗死的一种有效手段。

BACKGROUND：A surgery can relieve the increased intracranial pressure, brain tissue edema, and brain stem compression in patients with massive cerebral infarction, and reduce the risk of serious complications, provide more time for medical treatment, and decrease the mortality and disability rate.OBJECTIVE：To investigate the clinical value of decompressive craniectomy plus temporal muscle sticking therapy of cerebral infarction.METHODS：A retrospective analysis was performed among the clinical data of 37 cerebral infarction patients, including 24 males and 13 females, they aged 10-55 years old. After decompressive craniectomy plus temporal muscle sticking therapy, the involved patients were fol owed up. The prognosis was evaluated according to the Glasgow Outcome Scale, as excel ent, good, moderate, none, and poor.RESULTS AND CONCLUSION：At 6 months of fol ow-up, the total efficiency of surgical treatment in 37 patients was up to 89%, including excel ent in 5 cases （14%）, good in 15 cases （41%）, moderate in 13 cases （35%）, none in 4 cases （11%）. No cases exhibited aggravation. Thirty-one patients with cerebral infarction were detected by cranial CT scans, among them 19 patients exhibited significantly reduced infarct size, and 12 patients who had self-care ability were found to restore the cerebral cortex activity. During the 1-year fol ow-up, 31 patients completed the fol ow-up, the remaining 6 cases were lost due to contact failure. Twenty-three cases achieved satisfactory long-term results, and returned to normal work and simple labor, two cases occurred contralateral cerebral infarction and became sicker. Decompressive craniectomy plus temporal muscle sticking therapy is an effective treatment for the majority of cerebral infarction.