幕上恶性脑梗死去骨瓣减压联合内减压术治疗临床观察

Clinical efficacy of decompressive craniectomy combined with internal decompression in the treatment of supratentorial malignant cerebral infarction

目的目前幕上恶性脑梗死的主要治疗方式为去骨瓣减压术,但疗效往往较差,探索更为有效的治疗方式是临床研究的重要方向之一。本研究探讨去骨瓣减压联合内减压术治疗幕上恶性脑梗死的临床疗效。方法选择焦作市人民医院神经外科2013-01-01-2018-01-01收治的73例幕上恶性脑梗死患者作为研究对象,其中42例采取去骨瓣减压联合内减压术治疗者为观察组,31例采取单纯去骨瓣减压术治疗者为对照组。比较两组术前及术后1周美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分、术后3个月Barthel指数(Barthel index,BI)评分以及术后并发症。结果术后1周,观察组NHISS评分为(17.36±1.47)分,低于对照组的(20.21±1.25)分,t=8.71,P<0.05。术后3个月BI评分评价预后,观察组恢复良好17例(40.5%),高于对照组的4例(12.9%),χ~2=9.60,P=0.008。术后3个月观察组坠积性肺炎发生11例(26.2%),低于对照组的27例(87.1%),χ~2=26.509,P<0.001;观察组深静脉血栓发生5例(11.9%),低于对照组的11例(35.5%),χ~2=6.308,P=0.012。两组术后脑出血、颅内感染、应激性溃疡、癫痫及压疮等并发症发生率差异无统计学意义,均P>0.05。结论幕上恶性脑梗死采取去骨瓣减压术联合内减压治疗可改善患者预后,较单一去骨瓣减压术治疗效果好。

OBJECTIVE At present,the main treatment of malignant cerebral infarction is decompressive craniectomy,but the curative effect is often poor.Exploring more effective treatment is one of the important directions of clinical research.The purpose of this study is to investigate the clinical effect of decompressive craniectomy combined with internal decompression in the treatment of supratentorial malignant cerebral infarction.METHODS A total of 73 patients with supratentorial malignant cerebral infarction admitted to the Department of Neurosurgery of Jiaozuo People’s Hospital from January 1,2013 to January 1,2018 were selected as the study subjects.42 cases were treated with decompression combined with internal decompression as the observation group,and 31 cases were treated with decompression alone as the control group.The national institutes of health stroke scale(NIHSS)score,Barthel index(BI)score and postoperative complications were compared between the two groups before operation as well as at 1 week and 3 months after operation.RESULTS One week after operation,the NHISS score of the observation group was(17.36±1.47),lower than that of the control group(20.21±1.25),t=8.71,P<0.05.The prognosis was evaluated by BI score at 3 months after surgery,and 17 cases(40.5%)recovered well in the observation group,higher than 4 cases(12.9%)in the control group,the difference was statistically significant,χ^2=9.60,P=0.008.The incidence of falling volume pneumonia in the observation group was 11 cases(26.2%)at 3 months after surgery,lower than that in the control group 27 cases(87.1%),with statistically significant difference(χ^2=26.509,P<0.001).The incidence of deep venous thrombosis in the observation group was 5 cases(11.9%),lower than that in the control group(35.5%),with statistically significant difference(χ^2=6.308,P=0.012).There were no significant difference in the incidence of complications such as cerebral hemorrhage,intracranial infection,stress ulcer,epilepsy and bedsore between the two groups,all P>0.05.CONCLUSION Decompressive craniectomy combined with internal decompression can improve the prognosis of patients with supratentorial malignant cerebral infarction compared with single decompressive craniectomy.