去骨瓣减压术治疗恶性大脑中动脉供血区脑梗死效果分析  

Decompressive Craniectomy in Malignant Middle Cerebral Artery Territory Infarction

作　　者：费力[1] 吴海兵[1] 李荣刚[1] 杜嘉瑞[1] 王尔松[1] 张维[1] 

机构地区：[1]复旦大学附属金山医院神经外科,上海市201508

出　　处：《中国全科医学》2015年第5期595-598,共4页Chinese General Practice

基　　金：上海市金山区科委资助项目(2010-3-03)

摘　　要：背景恶性大脑中动脉供血区脑梗死(MMCI)患者传统保守治疗的病死率高达80%,去骨瓣减压术(DC)能显著降低MMCI的病死率。但临床上DC在MMCI患者中的使用比例并不高,在手术指征和手术时机的选择方面仍存在诸多争议。目的探讨DC治疗MMCI的临床效果。方法选取2009年1月—2013年6月复旦大学附属金山医院收治的MMCI患者24例,其中行DC手术患者12例(DC组),拒绝行DC手术患者12例(传统组)。DC组患者采取DC治疗,传统组患者采用一般治疗。观察两组患者的治疗效果及预后,并对行DC年龄≥65岁(6例)和<65岁(6例)患者的预后情况进行分析。结果两组患者年龄构成比较,差异有统计学意义(P=0.034);两组性别、既往史比较,差异均无统计学意义(P>0.05)。DC组患者术后死亡3例(25%),传统组患者分别在发病1周内死亡或在出现脑疝和/或中枢性呼吸循环衰竭时放弃治疗。≤65岁和>65岁患者术后改良Rankin量表(mRS)评分和病死率比较,差异均无统计学意义(P>0.05)。结论 DC能显著降低MMCI患者的病死率,在>65岁以上的老年患者中同样有效;多数MMCI患者DC术后神经功能预后不佳;对存在致命性脑水肿风险的大面积脑梗死患者,治疗中强调多科室合作并与患者家属进行包括长期预后方面的有效沟通。Background Malignant middle cerebral artery territory infarction（ MMCI） is associated with a mortality rate of 80% if treated conservatively. Though decompressive craniectomy（ DC） has been unequivocally shown to reduce the mortality rate of these patients,but the application rate of DC in clinic remains low. There is ongoing debate about the operative indication and timing. Objective To study the clinical effect of DC in treating MMCI patients. Methods 24 MMCI patients visiting Jinshan Hospital Affiliated to Fudan University from January 2009 to June 2013 were selected as the research subjects and divided into DC group including 12 patients who agreed and tradition group including the other 12 patients who denied. The clinical effects and prognosis of the 24 MMCI patients and the prognosis of the DC patients including 6 whose age was ≥65 and the other 6 65 were analyzed. Results The difference in age between two groups of patients was significant（ P = 0. 034）; the differences in gender and past history were not significant（ P〉0. 05）. 3 patients died after DC operation（ 25%） and the 12 patients who treated conservatively were died within one week or gave up treatment because of brain herniation and central respiratory failure. The differences in mRS score and mortality rate between patients ≥ 65 years and 65 years were not significant（ P〉0. 05）. Conclusion DC can significantly reduce the mortality rate of MMCI patients and it is also effective in elderly patients over 65; the majority of the DC- treated MMCI patients is found with poor nerve functional prognosis; while treating patients with large- area cerebral infarction who are at high risk of brain edema, it is needed to emphasize close coordination with multiple departments and effective communication with the patients＇ relatives on long- term prognosis.

关 键 词：脑梗死 大脑中动脉 去骨瓣减压术 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]