早期标准大骨瓣开颅减压治疗大面积脑梗塞  

Early decompression by standard craniectomy to treat extensive infarction

作　　者：王洪正[1] 田冰[1] 戴黎萌[2] 沈伟锋[1] 陈育光 许燕球[1] 李品成 王雪新[1] 吴耀晨[2] 

机构地区：[1]广东省惠州市惠阳人民医院神经外科,516211 [2]广东省深圳市人民医院神经外科,518020

出　　处：《中国实用医药》2007年第7期8-10,共3页China Practical Medicine

摘　　要：目的探讨早期行标准大骨瓣开颅减压治疗大面积脑梗塞可否提高病人的疗效、降低死亡率。方法51例因一侧完全性的大脑中动脉供血区脑梗塞而施行了标准大骨瓣开颅减压手术病人的资料。术前以全国第四次脑血管病学术会议通过的“脑卒中患者临床神经功能缺损程度评分标准”及the Glasgow Coma Scale(GCS)进行评估。以发病至手术的时间为界将病人分为两组,即早期手术组和晚期手术组。所有生存者在术后3个月按Barthel Index(BI)进行神经功能评估。结果晚期手术组病人从发病到手术的平均时间是51h,而早期组为28h。早期组死亡率为14.3%(3/21),而晚期组为26.7%(8/30)。术前出现颞叶钩回疝并有单侧瞳孔散大固定者,在晚期治疗组为80%(24/30),而早期手术组仅为13.5%(3/21)(P<0.001);术后3个月以BI评估病人的神经功能情况是早期组为69.8分,晚期组为61.7分(P<0.05)。结论早期施行标准大骨瓣开颅减压治疗大面积脑梗塞能显著提高病人的生存率及生存质量。Objective To investigate the matter that if early decompression by standard craniectomy to treat extensive infarction can enhance the curative efficacy and help to lower mortality. Methods Fity-one patients who underwent standard large craniectomy decompression for large middle cerebralartery territory infarction were reviewed and analyzed retrospectively,the patients were assessed by Chinese scale of clinical neurologic deficit of stroke patients (Chinese Scale) and the Glasgow Coma Scale (GCS) before operation. According to the length of time that between the stroke patients symptom onset and operation. We divided the patients into two groups: early decompressive surgery group (≤36 hours after symptom onset) and late surgery group (>36 hours after symptom onset). All survivors were reexamined 3 months after surgical decompression, with the clinical evaluation graded according to the Barthel Index (BI). Results In 21 patients with early decompressive surgery, mortality was 14.3%(3/21) and BI score 69.8; In 30 patients with late surgery, mortality was 26.7%(8/30) and BI score 61.7.13.5%(3/21)patients with the signs of herniation before surgery in the early treated group versus 80%(24/30)patients in the late treated group(P<0.01).Conclusion Early standard large craniectomy decompression for large middle cerebral artery territoryinfarction patients,can significantly improves the curative effectiveness of the patients,and can help to lower mortality rate and to improve patients’ living quality.

关 键 词：脑梗塞 脑水肿 标准大骨瓣开颅减压 机能恢复 

分 类 号：R743.3[医药卫生—神经病学与精神病学]