微创抽吸坏死脑组织治疗老年重症大脑半球大面积梗死的临床疗效  

Clinical efficacy of minimally invasive aspiration of necrotic brain tissues in treatment of elderly patients with severe large hemispheric infarction

作　　者：陈致远 董成龙 陈茂刚 王治瑜 骆锦标[4] 孙树杰 CHEN Zhiyuan;DONG Chenglong;CHEN Maogang(Department of Neurology,Yancheng School of Clinical Medicine,Nanjing Medical University,Yancheng 224000,CHINA)

机构地区：[1]南京医科大学盐城临床医学院(盐城市第三人民医院)神经内科,江苏盐城224000 [2]徐州医科大学盐城临床学院(盐城市第一人民医院)急诊科 [3]上海市徐汇区中心医院(复旦大学附属中山医院徐汇医院)神经外科 [4]广州市第一人民医院神经外科

出　　处：《江苏医药》2022年第11期1093-1096,共4页Jiangsu Medical Journal

基　　金：江苏省卫生健康委员会科研项目(LGY2019042);上海市徐汇区医学科研项目(SHXH201906)。

摘　　要：目的探讨微创抽吸坏死脑组织治疗老年重症大脑半球大面积梗死(LHI)患者的疗效和安全性。方法60例老年重症LHI患者分别采用定向置管抽吸坏死脑组织治疗(抽吸组,32例)和保守治疗(保守组,28例)。比较两组近、远期疗效和并发症发生率。结果保守组发病1周内脑疝发生率和治疗1个月内病死率均高于抽吸组(62.5%vs.14.3%和71.9%vs.10.7%)(P<0.01),两组治疗1个月内颅内血肿和颅内感染发生率差异无统计学意义(P>0.05)。治疗6个月后,保守组病死率高于抽吸组(78.1%vs.17.9%)(P<0.01),非重残生存率[改良Rankin量表(mRS)评分0~4分]低于抽吸组(12.5%vs.57.1%)(P<0.01),结局良好率(mRS评分0~3分)稍低于抽吸组(3.1%vs.21.4%)(P>0.05)。结论微创抽吸坏死脑组织可以降低老年重症LHI患者的病死率,改善预后,且安全性好。Objective To explore the efficacy and safety of minimally invasive aspiration of the necrotic brain tissues in the treatment of elderly patients with severe large hemispheric infarction.Methods Sixty elderly patients with severe large hemispheric infarction were treated with directional catheter aspiration of the necrotic brain tissues(group A,32 cases)and conservative treatment(group C,28 cases).The short-term and long-term efficacy and complication rate were compared between the two groups.Results The incidence of early cerebral hernia within 1 week of onset and the mortality within 1 month of treatment in group C were higher than those in group A(62.5%vs.14.3% and 71.9%vs.10.7%)(P<0.01).There was no significant difference in the incidence of intracranial hematoma and infection between the two groups within 1 month of treatment(P>0.05).Compared with group A after 6 months of treatment,group C had higher mortality(78.1%vs.17.9%)(P<0.01),lower survival rate without severe disability(modified Rankin scale 0-4 points)(12.5%vs.57.1%)(P<0.01),and slightly lower good outcome rate(modified Rankin scale 0-3 points)(3.1%vs.21.4%)(P>0.05).Conclusion Minimally invasive aspiration of the necrotic brain tissues can reduce the mortality and improve the prognosis of elderly patients with severe large hemispheric infarction.

关 键 词：脑梗死 微创手术 老年 

分 类 号：R743[医药卫生—神经病学与精神病学]