不同手术时机治疗大面积脑梗死的疗效分析

Analyze the curative effect of treating large area cerebral infarction at different occasion

目的比较分析大面积脑梗死的不同治疗方法的临床疗效,为临床提供参考。方法 2009年1月至2013年12月急诊入院的76例急性大面积脑梗死患者随机分为三组,A组为内科治疗组20例;B组为脑疝晚期手术治疗组27例;C组为脑疝早期手术治疗组29例。A组采用脱水脑保护改善循环抗感染及对症支持等治疗,B组是在A组治疗无效的基础去骨瓣减压术治疗;C组采用在脑疝发生之前采用去骨瓣减压术治疗。观察1个月按美国国立卫生研究院卒中量表(NIHSS)评分并统计分析疗效。结果治疗观察1个月后A组总有效率为35%,B组总有效率为63%,C组总有效率为69%,组间差异有统计学意义(P<0.05);A组、B组和C组治疗后NIHSS评分较治疗前均明显降低差异有统计学意义(P<0.05);治疗后三组间比较NIHSS评分差异有统计学意义(P<0.05)。结论早期行去骨瓣减压术治疗大面积脑梗死效果较好,能明显改善患者的神经功能缺损程度。

Objective Compared the clinical efficacy of treat large area cerebral infarction at different occasion. Methods 76 cases of large area cerebral infarction patients,got into hospital during January 2009 and December 2013,were divided into three groups. Group A was internal medicine group( n = 20),group B was advanced hernia group( n = 27) and group C was early stage brain hernia group( n = 29). Patients in group A were treated with cerebral protection,the improvement of circulating,anti infection and supportive treatment. Patients in group B received craniectomy to depress based on the treatment of group A. Patients in group C received craniectomy to decompress before cerebral hernia occurred. Analyze the efficacy one month later by using Health Stroke Scale( NIHSS) score of USA National Institutes. Results Total effective rate of group A,B and C were 35%,63% and 69% separately. The differences of total effective rate among the three groups were statistically significant( P < 0. 05). NIHSS score of the three groups were decreased significantly compared with those before treatment( P < 0. 05). The differences of NIHSS score among the three groups were statistically significant( P < 0. 05). Conclusions Do craniectomy early to decompress is effective for large area cerebral infarction for it can significantly improve the degree of neurological impairment.