微创抽吸联合侧脑室引流治疗老年恶性大脑中动脉梗死患者的对照研究

A controlled study of minimally invasive aspiration of necrotic brain tissue plus lateral ventricular catheter drainage in the treatment of elderly patients with malignant middle cerebral artery infarction

目的探讨微创抽吸坏死脑组织联合侧脑室引流治疗60~80岁恶性大脑中动脉梗死患者的效果和安全性。方法收集2018年1月至2019年12月就诊于盐城市第一人民医院的46例年龄60~80岁恶性大脑中动脉梗死患者,将其中采用微创抽吸联合侧脑室引流治疗的21例设为抽吸组,将采用保守治疗的25例设为保守组。比较两组的近、远期疗效和并发症发生率。结果保守组和抽吸组1个月的病死率分别为68.0%(17/25)、9.5%(2/21),1周内早期脑疝发生率分别为68.0%(17/25)、14.3%(3/21),差异均有统计学意义(P<0.001);两组的颅内血肿和颅内感染发生率比较,差异均无统计学意义(P>0.05)。保守组和抽吸组6个月的死亡率分别为76.0%(19/25)、14.3%(3/21),6个月改良Rankin量表(mRS)0~4分的所占比例分别为12.0%(3/25)、61.9%(13/21),差异均有统计学意义(P<0.001);保守组和抽吸组6个月的mRS 0~3分的比率分别为4.0%(1/25),23.8%(5/21),差异无统计学意义(P>0.05)。结论微创抽吸坏死脑组织联合侧脑室引流可以降低老年恶性大脑中动脉梗死患者的死亡率,改善预后,且具有安全性。

Objective To explore the efficacy and safety of minimally invasive aspiration of necrotic brain tissue combined with lateral ventricular catheter drainage for patients with malignant middle cerebral artery infarction aged between 60 and 80.Methods We collected 46 patients(60-80 years old)with malignant middle cerebral artery infarction,who were treated in Yancheng No.1 People's Hospital from January 2018 to December 2019.Among them,21 patients who were treated with invasive aspiration of necrotic brain tissue plus lateral ventricular catheter drainage were assigned as the aspiration group,and 25 patients who were treated conservatively were assigned as the conservative group.The short-term and long-term efficacy and incidence of complications were compared between the two groups.Results The 1-month mortality rates of the conservative group and the aspiration group were 68.0%(17/25)and 9.5%(2/21),respectively.The incidence of early cerebral hernia within 1 week was 68.0%(17/25)and 14.3%(3/21),respectively.The differences were statistically significant(P<0.001).There was no statistical difference in the incidence of intracranial hematoma and intracranial infection between the two groups(P>0.05).The 6-month mortality rate of the conservative group and the aspiration group were 76.0%and 14.3%,respectively.The rates of the conservative group and the aspiration group for a score of 0 to 4 on the modified Rankin Scale(mRS)were 12.0%(3/25)and 61.9%(13/21),respectively.The differences were statistically significant(P<0.001).The rates of the conservative group and the aspiration group for a score of 0 to 3 on the mRS were 4.0%(1/25)and 23.8%(5/21),respectively,with no statistically significant difference(P>0.05).Conclusions The study initially showed that minimally invasive aspiration of necrotic brain tissue plus lateral ventricular catheter drainage can reduce the mortality and improve the prognosis of elderly patients with malignant middle cerebral artery infarction,and it is safe.