去骨瓣减压术治疗大面积脑梗死的获益年龄和手术时机

The benefit age and operation time of decompressive craniectomy in the treatment of massive cerebral infarction

目的:探讨去骨瓣减压术治疗大面积脑梗死的获益年龄、手术时机及手术指征。方法:收治大面积脑梗死患者47例,给予去骨瓣减压术,按患者年龄分为中年组(≤60岁)和老年组(>60岁),按手术距发病时间分为早期手术组(≤36 h)和晚期手术组(>36 h),分别比较两组患者死亡率、术后1个月及术后半年mRS评分。结果:中年组术后1个月及半年随访康复好转率明显好于老年组(P<0.05)。早期手术组和晚期手术组在死亡率、术后1个月及半年随访康复好转率差异均无统计学意义(P>0.05)。结论:去骨瓣减压术可降低各年龄段大面积脑梗死患者的死亡率,中年组较老年组术后康复良好率高。应根据患者术前临床症状、查体、影像学检查严格把握手术指征,确定最佳手术时机。

Objective:To explore the benefit age,operation time and operation indication of decompressive craniectomy in the treatment of massive cerebral infarction.Methods:47 patients with massive cerebral infarction were selected.They were given decompressive craniectomy.According to the patient ages,they were divided into the middle age group(less than or equal to 60 years old) and the old group(more than 60 years old).According to the operation from the onset time,they were divided into the early surgery group(less than or equal to 36 hours) and the late surgery group(more than 36 hours).The mortality,postoperative 1 month and postoperative half year mRS score of two groups were respectively compared.Results:The rehabilitation improvement rate of postoperative 1 month and half year follow-up of the middle age group was better than that of the old group(P < 0.05).The differences of mortality,postoperative 1 month and postoperative half year mRS score between the early surgery group and the late surgery group were not statistically significant (P > 0.05) .Conclusion:Decompressive craniectomy can reduce the mortality of patients with large area cerebral infarction in each age group,and the postoperative recovery good rate of the middle age group was higher than that of the old group.We should strictly grasp the surgical indications according to the preoperative clinical symptoms,physical examination and imaging examination,and determine the optimal operation time.