CAJ | 학술논문

目的：探讨大骨瓣减压手术治疗恶性脑梗死患者的疗效和影响因素。方法选取42例因恶性脑梗死行减压手术的患者，回顾分析患者年龄、入院时及术前格拉斯哥昏迷评分（GCS）、术前瞳孔变化、中线移位程度、起病至手术时间、手术方式与术后格拉斯哥预后评分（GOS）的关系，根据GOS将患者分为预后良好组（GOS 4~5分）与不良组（GOS 1~3分）进行比较。结果 GOS预后良好组18例（42.9%）；预后不良组24例（57.1%），其中死亡7例。两组患者年龄、术前是否出现两侧瞳孔不等大、术前GCS的差异均有统计学意义（均P＜0.05）。结论恶性脑梗死发生后，患者一旦出现意识障碍并进行性加重，应及时手术，尤其是相对年轻的患者；当患者出现深度昏迷（GCS＜8分）、瞳孔不等大时再进行手术，患者预后较差。手术的关键是制作足够大的骨瓣进行充分减压。
목적：탐토대골판감압수술치료악성뇌경사환자적료효화영향인소。방법선취42례인악성뇌경사행감압수술적환자，회고분석환자년령、입원시급술전격랍사가혼미평분（GCS）、술전동공변화、중선이위정도、기병지수술시간、수술방식여술후격랍사가예후평분（GOS）적관계，근거GOS장환자분위예후량호조（GOS 4~5분）여불량조（GOS 1~3분）진행비교。결과 GOS예후량호조18례（42.9%）；예후불량조24례（57.1%），기중사망7례。량조환자년령、술전시부출현량측동공불등대、술전GCS적차이균유통계학의의（균P＜0.05）。결론악성뇌경사발생후，환자일단출현의식장애병진행성가중，응급시수술，우기시상대년경적환자；당환자출현심도혼미（GCS＜8분）、동공불등대시재진행수술，환자예후교차。수술적관건시제작족구대적골판진행충분감압。
Objective To evaluate the clinical efficacy of decompressive hemicraniectomy in patients. Methods Forty two patients with malignant cerebral infarction were treated with decompressive hemicraniectomy. The clinical data including:age, Glasgow Coma Scale (GCS) score on admission and before surgery, anisocoria, degree of midline shift, the time from diag-nosis to surgery, surgical modalities were retrospectively reviewed. Clinical outcomes were assessed by the Glasgow Outcome Scale (GOS). Results Among 42 patients, 18(42.9%) achieved a good outcome(GOS4- 5) and 24(57.1%) had a poor outcome (GOS1- 3). Older age, presence of anisocoria before surgery and lower preoperative GCS score were associated with poor out-comes (P<0.05). Conclusion Patients with preoperative GCS score less than 8 and anisocoria has poor outcome of malignant cerebral infarction, so decompressive hemicraniectomy should be performed prior to the presence of anisocoria and increased disturbance of consciousness, especial y for younger patients.