DHMS量表在恶性大脑中动脉梗死手术时机选择中的应用  

The application of DHMS in the timing of surgery for the patients with malignant infarction of the middle cerebral artery

作　　者：黄巧英[1] 张睿[1] 黄鹤鸣[1] 赵永阳[2] 褚晓凡[1] 

机构地区：[1]暨南大学第二临床医学院神经内科,广东深圳100204 [2]暨南大学第二临床医学院神经外科,广东深圳100204

出　　处：《中风与神经疾病杂志》2011年第11期988-992,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的采用自制的去骨瓣减压手术治疗恶性大脑中动脉梗死量表(Decompressive Hemicraniec-tomyof Malignant middle cerebral artery infarction Scale,DHMS)对手术治疗时机进行探讨。方法 108例恶性大脑中动脉梗死患者共分为4组:(1)手术后存活组18例;(2)手术后死亡组9例;(3)无手术死亡25例;4)无手术存活56例。结合国内外文献及临床经验,根据手术风险及其获益,制定DHMS量表,并对4组患者进行统计分析。该量表共计5个大项目,总计10分。采用SPSS13.0统计软件对4组的评分进行多个独立样本比较的Kruskal-Wallis H检验。结果恶性大脑中动脉梗死的患者采用去骨辨减压手术后存活18例(66.7%),手术后死亡9例(33.3%)。采用DHMS量表计算4组的平均得分为:手术存活组4.67±2.275;手术死亡组3.67±2.179;非手术存活组2.86±2.058;非手术死亡组是5.64±1.89。经多个独立样本比较的Kruskal-Wallis H检验,卡方25.912,P=0.000,表示4组间评分有显著性差异。结论 DHMS量表对选择去骨瓣减压手术治疗恶性大脑中动脉梗死的时机具有一定的指导意义,DHMS量表≥4分可作为临床判断手术时机的一个衡量时机点。Objective Using the decompressive hemicraniectomy of malignant middle cerebral artery infarction scale（DHMS）,a self-made measuring scale,to investigate the proper timing of surgery.Methods 108 patients with malignant infarction of the middle cerebral artery were divided into four groups：（1）The survival group undergoing surgery included 18 cases;（2）The death group undergoing surgery included 9 cases;（3）The death group without surgery included 25 cases;（4）The survival group without surgery included 56 cases.After analyzing lots of literatures at home and abroad,and based on the risk and opportunity of surgery,We made DHMS on patients with malignant infarction of the middle cerebral artery,and we scored the four groups.This scale contained 5 big items,10points in total.We do multi-independent sample comparative Kruskal-Wallis H rank test on the scores of the four groups using SPSS13.0 statistic software.Results 18 patients（66.7%）with malignant infarction of the middle cerebral artery survived undergoing decompressive hemicraniectomy,9 patients（33.3%）died undergoing surgery.The ranks of four groups according to the scale were as follows：the score of the survival group undergoing surgery was 4.67±2.275;the score of the dead group undergoing surgery was 3.67±2.179;the score of the survival group without surgery was 2.86±2.058;and the score of the dead group without surgery was 5.64±1.89.According to multi-independent sample comparative Kruskal-Wallis H rank test,chi-square was 25.912,P=0.000.There was a significant difference among the four groups.Conclusion DHMS has a certain significance in choosing the timing of surgery for the patients with malignant infarction of the middle cerebral artery.DHMS ≥ 4 points can be used to determine the timing of surgery clinically.

关 键 词：恶性大脑中动脉梗死 去骨瓣减压术 DHMS量表 

分 类 号：R743[医药卫生—神经病学与精神病学]