标准大骨瓣开颅减压治疗大面积脑梗塞  

Decompression by standard craniectomy to treat extensive infarction

作　　者：王洪正[1] 戴黎萌[2] 许燕球[1] 赵万巨[3] 陈建良[2] 吴耀晨[2] 徐如祥[4] 

机构地区：[1]广东省惠州市惠阳人民医院神经外科,惠阳516211 [2]广东省深圳市人民医院神经外科,深圳518020 [3]山东省济宁医学院附属医院神经外科,济宁272029 [4]南方医科大学珠江医院神经外科,广州510282

出　　处：《中华神经医学杂志》2005年第11期1140-1142,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨标准大骨瓣开颅减压治疗大面积脑梗塞的手术适应证、手术方法及影响预后的因素。方法回顾性分析了1999年5月￣2005年5月间收治的31例因大面积脑梗塞而行标准大骨瓣开颅减压治疗的患者疗效,以GOS评分评定其临床效果。脑梗塞发病距手术时间平均为38h(24h￣5d)。结果所有病人均经随访,术后死亡6例(19.4%),其中年龄大于55岁者20例,死亡5例(25%);年龄小于55岁者11例,死亡1例(9%)。以GOS评价治疗效果,出院时死亡6例(19.4%),植物生存5例(16.1%),重残10例(32.2%),中残6例(19.4%),良好4例(12.9%);术后6个月死亡6例(19.4%),植物生存4例(12.9%),重残7例(22.6%),中残8例(25.8%),良好6例(19.4%)。结论标准大骨瓣开颅减压能极大提高大面积脑梗塞病人的生存率及生存质量,是传统保守治疗失败后的一极为有效疗法,其中手术技巧及手术时机的选择非常重要,年龄大于55岁及快速恶化者疗效较差。Objective To probe into the curative effect, time for operation and the factors associated with outcomes of decompression by standard large craniectomy to treat extensive infarction. Methods 31 cases who underwent decompression by standard craniectomy to treat extensive infarction between 1999 and 2005, were reviewed and analyzed retrospectively. The curative effectiveness was assessed according to Glasgow outcome scale （GOS）. Results All postoperative patients were followed-up for six months to one year. 6 patients died postoperatively with a mortality of 19.4%. Of all, 5 of 20 patients aged more than 55 years died, with a mortality of 25% and one of 11 patients aged less than 55 years died with a mortality of 9%. A score less than or equal to 3 by GOS was considered as poor effectiveness, more than 3 as effective. At discharge, 19 cases（61%） got unsatisfactorily recovered and 6 （19.4%） gained satisfactory outcome. Six months after operation, 15 cases（48%） got unsatisfactory outcome and 10cases（32%） got satisfactory outcome. Conclusion Decompression by standard craniectomy in the treatment of extensive infarction can significantly enhance the curative efficacy and help to lower mortality and improve patients＇ living quality. It is a rational alternative when the routine surgical therapy fails. However, decompressive craniectomy may be of less effect for rapidly worsening patients or those aged 〉50 years.

关 键 词：脑梗塞 标准大骨瓣 预后 

分 类 号：R651[医药卫生—外科学]