大面积脑梗死去骨瓣减压的手术时机及疗效分析

The chance of decompressivecraniectomy and its therapeutic effect on patients with large area cerebral infarction

目的探讨大面积脑梗死的手术时机的选择及其影响因素,提高大面积脑梗患者的预后。方法回顾分析2009年至2016年收治的164例大面积脑梗去骨瓣减压患者的资料,对比不同手术时间段患者的生存率及预后。结果患者Spitzer指数提示发病48h内手术患者的预后高于发病48h后的手术患者。当梗死体积大于250cm3时,患者48h内手术的生存率高于发病48h后的患者,差异有统计学意义(P=0.041)。脑疝早期患者48h内手术后生存率同48h后手术比较显著提高,生存率存在统计学差异(P=0.015)。结论发病48h内的大面积脑梗死患者早期接受手术治疗,可以显著提高生存率,改善预后。

Objective To investigate the timing of decompressivecraniectomy and its influencing factors so as to improve the clinical outcomes of patients with large area cerebral infarction.Methods We made a retrospective analysis of the survival and outcomes using clinical data from 164 large area cerebral infarction patients who underwent decompressivecraniectomy from 2009 to 2016 in the First Affiliated Hospital of Xi an Jiaotong University.Results Spitzer index indicated that the outcomes of patients who had undergone earlier surgical treatment(within 48 h)after cerebral infarctions were improved compared with those of the later surgery group patients(more than 48 h).Additionally,the survival of the earlier surgery group was significantly better than that of the later surgery group when cerebral infarction area was more than 250 cm 3(P=0.041).Moreover,earlier decompressivecraniectomy(within 48 h)significantly improved the postoperative survival for patients with cerebral hernation(P=0.015).Conclusion Decompressivecraniectomy within 48 hours after diagnosis of cerebral infarction can significantly improve survival rate and prognosis