去骨瓣减压术联合亚低温治疗大脑半球大面积梗死的效果观察

Effect of decompressive craniectomy combined with mild hypothermia in the treatment of large cerebral infarction

目的:探讨去骨瓣减压术(DC)联合亚低温治疗大脑半球大面积梗死(LHI)的临床效果。方法:抽取2018年7月至2020年7月郑州市第九人民医院收治的180例被诊断为LHI且具有完整随访记录的患者,按照随机数字表法将其分为三组,去骨瓣减压术组(DC组)60例、DC加头表面冷却组(DCSC组)60例和DC加血管内低温组(DCEH组)60例。比较三组患者一般资料、术后6个月Rankin量表(mRS)分级、术后并发症。结果:术后6个月DCSC组、DCEH组和DC组神经功能良好率(mRS 0~3级)分别为41.7%、35.0% 、21.7%,三组比较差异未见统计学意义( P>0.05)。DCSC组、DCEH组和DC组的病死率分别为45.0%、38.3% 、44.3%,三组比较差异未见统计学意义( P>0.05)。DCEH组并发症发生总次数为271次,多于DCSC组(220次)和DC组(203次),差异有统计学意义( P<0.05);DCEH组术后出现胃潴留49例,多于DCSC组(21例)和DC组(13例),差异有统计学意义( P<0.05)。 结论:DC联合亚低温不能改善LHI患者的神经系统预后、降低病死率和减少并发症发生。DCEH可能导致LHI患者更易出现并发症,尤其是术后胃潴留。

Objective To investigate the clinical effect of decompressive craniotomy(DC)combined with mild hypothermia in the treatment of patients with large hemisphere infarction(LHI).Methods A total of 180 patients treated in the Ninth People’s Hospital of Zhengzhou from July 2018 to July 2020 who were diagnosed with LHI and all had complete follow-up records.According to the random number table method,the patients were randomly divided into three groups:decompressive craniectomy group(DC group,n=60),DC combined with head surface cooling group(DCSC group,n=60)and DC combined with intravascular hypothermia group(DCEH group,n=60).The general data,the modified Rankin Scale(MRS)grades at six months after operation,and the various complications after operation of the three groups were compared.Results The rates of good neurological function(mRS 0-3)of DCSC group,DCEH group and DC group at 6 months after operation were 41.7%,35.0%,21.7%,respectively,and the differences in the three groups were not statistically significant(P>0.05).The mortalities of DCSC group,DCEH group and DC group were 45.0%,38.3%,44.3%,respectively,the differences in the three groups were not statistically significant(P>0.05).The total number of complications in the DCEH group was 271,which was more than that in the DCSC group(220 times)and the DC group(203 times),and the difference was statistically significant(P<0.05);49 patients in the DCEH group had gastric retention after operation,which was more than that in the DCSC group(21 patients)and the DC group(13 patients),and the difference was statistically significant(P<0.05).Conclusions DC combined with hypothermia does not improve neurologic prognosis,reduce case fatality and complications in patients with LHI.DCEH may also lead to more complications in patients with LHI,particularly postoperative gastric retention.