去骨瓣减压术治疗恶性大脑半球梗塞手术时机选择  

Clinical study of the timing of decompressive cranioectomy in treatment of malignant hemispheric infarction

作　　者：刘进平[1] 谭海斌[1] 王振宇[1] 李志立[1] 黄光富[1] 

机构地区：[1]四川省人民医院神经外科,四川成都610072

出　　处：《西部医学》2016年第6期805-810,共6页Medical Journal of West China

基　　金：四川省卫计委科技支撑计划(140083)

摘　　要：目的评价不同手术时机行去骨瓣减压术治疗恶性大脑半球梗塞的临床效果。方法分析我院神经外科2009年6月~2014年9月收治的55例恶性大脑半球梗塞患者的临床资料。其中发病48小时之内手术者17例,48小时之后手术者15例,单纯保守治疗者23例。通过对比分析患者发病后12个月时的mRS评分（modified Rankin scale）评价患者的临床疗效。结果延迟手术组的死亡率为33.33%,高于早期手术组（23.53%,P〈0.05）,但是明显低于保守治疗组（69.56%,P〈0.05）。延迟手术组有效率（mRS评分≤4）低于早期手术组（P〈0.05）,而高于保守治疗组（P〈0.05）。结论恶性大脑半球梗塞患者在发病48小时以后接受手术治疗仍可在一定程度上降低死亡率,改善神经功能。手术时机的选择应根据患者的意识状态、瞳孔变化以及动态头颅CT检查结果等进行个体化判断,而不以某个时间点作为是否手术的依据。Objective To assess the clinical effects of decompressive cranioectomy at different time point in treatment of malignant hemispheric infarction.Methods The medical records of 55 patients with malignant hemispheric infarction treated in our department from June 2009 to September 2014 were analyzed.Fifteen cases operated 48 hours after onset of the infarction.17 cases operated within 48 hours and 23 cases received only conservative management.The mRS（modified Rankin scale）scores at the twelfth month were compared among conservative group and operation groups at different time.Results The mortality rate in delayed operation group（33.33%）was lower than that of early operation group（23.53%,P〈0.05）,and higher than that of the conservative group（69.56%,P〈0.05）.Moreover,the mRS 0-4at the twelfth in the delayed operation group was lower than in that in the early operation group,and higher than conservative group（P〈0.05）.Conclusion Decompressive cranioectomy at 48 hours after onset of malignant hemispheric infarction is also effective on reducing the overall mortality and morbidity.The timing of operation should be decided individually according to the conscious level,change of pupil and dynamic CT scanning rather than a certain time point.

关 键 词：去骨瓣减压术 大脑半球梗塞 手术时机 

分 类 号：R651.11[医药卫生—外科学]