标准去大骨瓣减压加内减压术治疗急性大面积脑梗死的临床经验分析

Clinical experience analysis of standard large decompressive craniectomy and internaldecompression to treat acute massive infraction decompression in large area

目的探讨大骨瓣减压术加内减压术治疗大面积脑梗死的临床疗效。方法回顾性分析河南省三门峡市中心医院2013—02～2017—03大面积脑梗死手术患者119例，采用标准大骨瓣减压术加内减压术治疗的患者62例为研究组，单纯标准大骨瓣减压术治疗患者57例为对照组，将两组进行对比分析，总结预后及手术经验。结果两组患者术前脑梗死面积及GCS评分差异均无统计学意义（P〉0．05）；术后7d，研究组患者脑梗死面积明显小于对照组患者，GCS评分明显高于对照组，差异均有统计学意义（P〈0．05）。其中对照组患者57例，存活43例，死亡14例。存活患者随访6个月，按格拉斯哥预后评分（GOS），恢复良好l例，中度残疾10例，重度残疾13例，植物生存19例。研究组患者62例，存活53例，死亡9例，存活患者随访6个月，按GOS评分，恢复良好4例，中度残疾16例，重度残疾23例，植物生存10例，两组相比差异有统计学意义，且研究组致死率、致残率、并发症发生率均明显降低（均P〈0．05）。结论标准大骨瓣减压术加内减压术能明显降低大面积脑梗死患者的死亡率和致残率，尽早手术内外充分减压，可减少术后并发症，最大限度挽救患者生命，改善预后，提高其生活质量。

Objective To analyze the clinical efficacy of standard large decompressive cranieetomy and internal decompression to treat acute massive infraction decompression in large area. Methods We reviewed the clinical data of 119 patients who were diagnosed as acute massive infraction decompression in large area in our hospital from February 2013 to March 2017, in which 62 patients were treated by standard large decompressive craniectomy and internal decompression, and the rest 57 patients were treated by standard large deeompressive cranieetomy only. The prognosis and surgical experience were analyzed retrospectively. Results There was no difference in cerebral infarction and （ Glasgow Coma Scale） GCS in two groups （P 〉 0.05 ）. But there was a significant difference of GCS in two groups after 7 days operation（P 〈 0.05）. After operation, 43 patients survived and 14 died in standard large decompressive craniectomy group, while 53 patients survived and 9 died in standard large decompressive craniectomy and internal decompression group. According to Glasgow Outcome Score （GOS） 6 months later, 1 patients recovered well, 10 patients had moderate disability, 13 patients had severe disability and 19 patients were in a vegetative state in standard large decompressive craniectomy group, while 4patients recovered well, 16 patients had moderate disability, 23 patients had severe disability and 10 patients were in a vegetative state in standard large decompressive craniectomy and internal decompression group. The later operation can decrease mortality and disability of patients significantly than the former operation （P 〈 0.05 ）. Furthermore, the standard large decompressive craniectomy and internal decompression operation can reduce post - operation complication significantly in acute massive infraction decompression in large area than the only standard large decompressive craniectomy operation （P 〈0.05）. Conclusion Standard large decompressive craniectomy and internal decompression can significantly reduce the mortality and disability of patients with acute massive cerebral infarction in large area. Early surgical intervention and full decompression should be performed to save the lives of patients, reduce post - operation complications, improve prognosis and the quality of life.