去骨瓣减压与内科保守治疗大面积脑梗死初步疗效的比较研究

Pilot study of comparison of therapeutic effect of decompressive craniectomy vs conservative treatment in patients with large hemispheric infarction

目的探讨外科去骨瓣减压术和内科保守治疗对大面积脑梗死的疗效。方法选择沈阳军区总医院2010年8月-2013年10月收治的69例大面积脑梗死患者,按治疗情况分为内科保守治疗组(n=53)与手术治疗组(n=16),对比两组患者死亡发生率,对存活者采用美国神经功能缺损评分(NIHSS)标准进行疗效评估。结果手术治疗组死亡发生率(12.5%)明显低于内科保守治疗组(39.6%,P<0.05);两组存活者治疗后的NIHSS评分均较治疗前明显降低,且两组间差异有统计学意义(19.38±1.86 vs 13.21±2.05,P<0.05);手术治疗组神经功能恢复明显优于内科保守治疗组。结论手术治疗能降低脑梗死患者的死亡发生率,提高患者生活质量,对具备手术指征的患者应争取尽早行手术治疗。

Objective To compare the results of decompressive craniectomy and conservative treatment in patients with massive hemispheric infarction. Methods According to treatment methods, 69 patients with massive hemispheric infarction, admitted during Aug. 2010 to Oct. 2013, were divided into two groups： general medical conser vative treatment（group 1） and surgery（group 2）. The mortality rate of the both groups was analyzed, and neurological deficits was evaluated in survivors by NIHSS criteria. Results The mortality rate was significantly lower in group 2 than in group 1（12.5% vs 39.6%, P〈0.05）. For survivors, the NIHSS score was reduced significantly after treatment in all the two groups, and there was a significant difference between the two groups（P〈0.05）. As improvement in neurological function was compared, the result in surgical treatment group was much better than that in medical conservative treatment group. Conclusion Decompressive surgery can reduce the mortality rate in patients with massive hemispheric infarction, and it improves their quality of life, therefore surgery should be done for the patients with surgical indications as soon as possible.