急性脑梗塞机械取栓术后出现大面积脑梗塞行去骨瓣及内减压术临床效果的研究  

STUDY ON CLINICAL EFFECT OF CRANIOCEREBRAL FLAP REMOVAL AND INTERNAL DECOMPRESSION AFTER MECHANICAL THROMBECTOMY FOR ACUTE CEREBRAL INFARCTION

作　　者：赵丽新 秦震新[1] 高健 杨芳杰 张洁[1] 吴艳军 李冠霞 李义靖 ZHAO Lixin;QIN Zhenxin;GAO Jian;YANG Fangjie;ZHANG Jie;WU Yanjun;LI Guanxia;LI Yijing(Tangshan People's Hospital,Tangshan 063000,China)

机构地区：[1]河北省唐山市人民医院,063000

出　　处：《中国煤炭工业医学杂志》2021年第6期594-598,共5页Chinese Journal of Coal Industry Medicine

基　　金：2019年度河北省医学科学研究课题计划(编号:20191594)。

摘　　要：目的探讨急性脑梗塞机械取栓术后出现大面积脑梗塞行去骨瓣及内减压术的治疗效果。方法回顾分析本院2017年3月—2020年3月接受机械取栓术后出现大面积脑梗塞的71例患者,根据治疗方法的不同分为观察组和对照组。对照组患者35例,行吸氧、脱水降颅压、改善微循环、抗凝、补液等支持治疗。观察组患者36例,在与前者有相同的支持治疗前提下进行去骨瓣减压术及部分脑组织切除的内减压术。并对观察组和对照组患者治疗前后的日常生活能力(ADL)评分,美国国立卫生研究院卒中量表(NIHSS)评分及格拉斯哥预后(GOS)评分进行比较,比较二组患者白介素-6(IL-6)、白介素-8(IL-8)、白细胞介素-1β(IL-1β)三种与炎症密切相关的炎症因子指标。结果观察组NIHSS评分、ADL评分、GOS预后评分分别为:(10.69±1.51)、(60.89±7.18)、(11.57±1.38),均明显优于对照组,二组三种评分比较差异均有统计学意义(P<0.05),观察组的治疗效果明显优于对照组,且二组比较差异有统计学意义(P<0.05)。行去骨瓣减压及内减压术后的观察组炎症因子较一般支持治疗后的对照组炎症因子明显降低,差异有统计学意义(P<0.05)。结论机械取栓后大面积脑梗塞的患者行去骨瓣及内减压手术治疗能明显提高患者生存率及神经功能康复,降低炎症因子指标,改善患者的预后情况。Objective To investigate the therapeutic effect of large cerebral infarction and internal decompression after acute cerebral infarction.Methods Seventy-one patients with large cerebral infarction after mechanical thrombolysis from March 2017 to March 2020 were divided into observation and control groups by random sampling.There were thirty-five patients with oxygen absorption, dehydration and reduced cranial pressure, improved microcirculation, anticoagulant, rehydration, and nutritional support.There were thirty-six patients in the observation group with conservative treatment basis of upward boneless valve and internal decompression in the control group.The group compared the National Institutes of Health Stroke Scale(NIHSS) score before and after treatment, daily living capacity(ADL) score and Glasgow prognosis(GOS) score, and three inflammatory factors closely related to inflammation: Interleukin-6(IL-6),Interleukin-8(IL-8) and Interleukin-1β(IL-1β).Results The NIHSS score(10.69±1.51),ADL score(60.89±7.18) and GOS score(11.57±1.38) were significantly better than the control group(P<0.05),significantly better than the control group and differences(P<0.05).The inflammatory factor was significantly lower and statistically significant(P<0.05).Conclusion Debone valve and internal decompression of patients with large cerebral infarction after mechanical thrombolysis can significantly improve the survival rate and neurological rehabilitation, reduce the inflammatory factor index and improve the prognosis of patients.

关 键 词：机械取栓 大面积脑梗塞 去骨瓣及内减压术 

分 类 号：R741[医药卫生—神经病学与精神病学]