机械取栓联合预见性去骨瓣减压加颞肌贴附术治疗血管再闭塞性大面积脑梗死的效果分析  

Effect Analysis of Mechanical Thrombectomy Combined with Foreseeable Decompression of Bone Flap Plus Temporalis Attachment in Treatment of Large Area Cerebral Infarction with Recurrent Vascular Occlusion

作　　者：周志国[1] 陈静[1] 朱青峰[1] ZHOU Zhiguo;CHEN Jing;ZHU Qingfeng(PLA 264st Hospital,Taiyuan 030001,China)

机构地区：[1]解放军264医院,山西太原030001

出　　处：《中国医学创新》2018年第21期19-23,共5页Medical Innovation of China

基　　金：2012年;2016年山西省科技攻关课题(20120313018-2;201603D321061)

摘　　要：目的:探讨机械取栓联合超早期预见性去骨瓣减压手术加颞肌贴附术治疗血管再闭塞性大面积脑梗死的疗效,总结血管闭塞性大面积脑梗死的有效治疗方法。方法:选取2016年2月-2018年2月本院收治的经血管内治疗后血管再次闭塞导致大面积脑梗死患者53例。按照不同治疗方法将其分为联合组(机械取栓联合预见性大骨窗去骨瓣减压术加颞肌贴附术)28例,去骨瓣减压组(预见性大骨窗去骨瓣减压术加颞肌贴附术)14例,机械取栓组(机械取栓术)11例。比较各组治疗前后的神经功能(NIHSS评分)及预后。结果:本组53例患者中存活45例,8例死亡,其中机械取栓组死亡5例(45.0%),去骨瓣减压组死亡3例(21.0%),联合组无死亡病例(恢复良好23例,轻残5例);术前,各组NIHSS评分比较差异无统计学意义(P>0.05),术后各组NIHSS评分比较差异有统计学意义(P<0.05),且联合组NIHSS评分均低于机械取栓组和去骨瓣减压组,比较差异均有统计学意义(P=0.013、0.028)。结论:积极行血管再通治疗,早期评估血管再通及侧支循环水平,行超早期预见性去骨瓣减压加颞肌贴附术,对降低血管闭塞性大面积脑梗死患者死亡率及改善神经功能预后有积极意义。Objective：To explore the therapeutic effect of mechanical thrombectomy combined with ultra early foreseeable decompression of bone flap plus temporalis attachment in treatment of large area cerebral infarction with recurrent vascular occlusion,to summarize the effective treatment of large area cerebral infarction with vascular occlusion.Method：A total of 53 patients with large area cerebral infarction with recurrent vascular occlusion after endovascular treatment from February 2016 to February 2018 in our hospital were selected.According to the different treatment methods,they were divided into 28 cases of combined group（mechanical thrombectomy combined with ultra early foreseeable decompression of bone flap plus temporalis attachment）,14 cases of bone flap decompression group（ultra early foreseeable decompression of bone flap plus temporalis attachment） and 11 cases of mechanical thrombectomy group（mechanical thrombectomy）.The neurological function（NIHSS score） and prognosis were compared before and after treatment.Result：53 patients,45 cases survived and 8 cases died,among them,5 cases（45.0%） died in mechanical thrombectomy group,3 cases（21.0%） died in bone flap decompression group,no death cases in combined group（23 cases recovered well and 5 cases mild disability）.Before operation,the NIHSS scores in each group were compared,the difference was not statistically significant（P〈0.05）,after operation,the NIHSS scores in each group were compared,the difference was statistically significant（P〈0.05）,and the NIHSS score of combined group was lower than that of mechanical thrombectomy group and bone flap decompression group,the differences were statistically significant（P=0.013,0.028）.Conclusion：Aggressive vascular recanalization therapy,early assessment of vascular recanalization and collateral circulation level,and ultra early foreseeable decompression of bone flap plus temporalis attachment,has a positive effect on reducing the mortality and improving the prognosi

关 键 词：大面积脑梗死 机械取栓 去骨瓣减压术 血管闭塞 

分 类 号：R743.33[医药卫生—神经病学与精神病学]