中华神经外科疾病研究杂志
中華神經外科疾病研究雜誌
중화신경외과질병연구잡지
Chinese Journal of Neurosurgical Disease Research
2015年
4期
338-341
,共4页
高亚飞%常涛%杨彦龙%李立宏
高亞飛%常濤%楊彥龍%李立宏
고아비%상도%양언룡%리립굉
大面积脑梗塞%大骨瓣手术%年龄
大麵積腦梗塞%大骨瓣手術%年齡
대면적뇌경새%대골판수술%년령
Massive cerebral infarction%Decompressive surgery%Age
目的：探讨大骨瓣减压术治疗大面积脑梗塞的疗效及相关因素对疗效的影响。方法回顾性分析2011年8月至2013年8月我科收治的71例确诊为大面积脑梗塞患者的治疗效果，其中58例采用手术治疗，13例采用药物保守治疗，分析不同治疗方案的疗效差别及年龄、手术时机、手术方式对手术效果的影响。结果两组患者的年龄、性别、GCS昏迷评分，差异无统计学意义（ P＞0．05）；两组患者治疗后1 w的生存率（P＝0．003）、治疗后6个月的生存率（P＝0．005）均有显著统计学差异；治疗后6个月，两组患者恢复不佳（mRS＞3）比率差异无统计学意义（P＝0．081）；手术患者术后1 w，≤60岁的病死率低（P＝0．042），发病48 h内手术的病死率低（P＝0．031），差异有统计学意义；术后6个月，≤60岁恢复良好（mRS≤3）的比率高（P＝0．031）；发病48 h内手术恢复良好（mRS≤3）的比率高（ P＝0．011）。结论大面积脑梗塞患者发病后诊断明确，早期（48 h内）手术治疗较保守治疗可提高术后1 w和术后半年的生存率，但是手术治疗不能改善术后半年的生存质量；年龄小于60岁，早期手术的患者术后1w病死率低，术后半年恢复良好。
目的：探討大骨瓣減壓術治療大麵積腦梗塞的療效及相關因素對療效的影響。方法迴顧性分析2011年8月至2013年8月我科收治的71例確診為大麵積腦梗塞患者的治療效果，其中58例採用手術治療，13例採用藥物保守治療，分析不同治療方案的療效差彆及年齡、手術時機、手術方式對手術效果的影響。結果兩組患者的年齡、性彆、GCS昏迷評分，差異無統計學意義（ P＞0．05）；兩組患者治療後1 w的生存率（P＝0．003）、治療後6箇月的生存率（P＝0．005）均有顯著統計學差異；治療後6箇月，兩組患者恢複不佳（mRS＞3）比率差異無統計學意義（P＝0．081）；手術患者術後1 w，≤60歲的病死率低（P＝0．042），髮病48 h內手術的病死率低（P＝0．031），差異有統計學意義；術後6箇月，≤60歲恢複良好（mRS≤3）的比率高（P＝0．031）；髮病48 h內手術恢複良好（mRS≤3）的比率高（ P＝0．011）。結論大麵積腦梗塞患者髮病後診斷明確，早期（48 h內）手術治療較保守治療可提高術後1 w和術後半年的生存率，但是手術治療不能改善術後半年的生存質量；年齡小于60歲，早期手術的患者術後1w病死率低，術後半年恢複良好。
목적：탐토대골판감압술치료대면적뇌경새적료효급상관인소대료효적영향。방법회고성분석2011년8월지2013년8월아과수치적71례학진위대면적뇌경새환자적치료효과，기중58례채용수술치료，13례채용약물보수치료，분석불동치료방안적료효차별급년령、수술시궤、수술방식대수술효과적영향。결과량조환자적년령、성별、GCS혼미평분，차이무통계학의의（ P＞0．05）；량조환자치료후1 w적생존솔（P＝0．003）、치료후6개월적생존솔（P＝0．005）균유현저통계학차이；치료후6개월，량조환자회복불가（mRS＞3）비솔차이무통계학의의（P＝0．081）；수술환자술후1 w，≤60세적병사솔저（P＝0．042），발병48 h내수술적병사솔저（P＝0．031），차이유통계학의의；술후6개월，≤60세회복량호（mRS≤3）적비솔고（P＝0．031）；발병48 h내수술회복량호（mRS≤3）적비솔고（ P＝0．011）。결론대면적뇌경새환자발병후진단명학，조기（48 h내）수술치료교보수치료가제고술후1 w화술후반년적생존솔，단시수술치료불능개선술후반년적생존질량；년령소우60세，조기수술적환자술후1w병사솔저，술후반년회복량호。
Objective The effect of decompressive surgery for the treatment of massive cerebral infarction and the factors related to outcomes are discussed.Methods Seventy-one cases with massive cerebral infarction treated in our department between August 2011 and August 2013, were reviewed and analyzed,retrospectively.Fifty-eight cases were treated by surgery while thirteen cases were treated by conservative treatment.The outcomes of two groups were compared and the related faactors were analyzed.Results There was no statistical difference in age, gender, GCS scores on admission between two groups (P>0.05).After treatment, the ratio of survival patients at 1 w (P=0.003) and 6 months (P=0.005) were significant different between two groups;no signficant difference was found in the ratio of poor recovery (mRS>3) between two groups (P=0.081).One month after opertaion, mortality was lower in patients≤60 years (P=0.042) and in patients who were operated within 48 h of stroke onset (P=0.031) with statistical difference between two groups.The ratio of good recovery (mRS≤3) was higher in patients≤60 years (P=0.031) and patients who were operated within 48 h of stroke onset ( P=0.011) at 6 months post-operation. Conclusion Decompressive craniectomy in the treatment of massive cerebral infarction can enhance the curative efficacy at 1 w and 6 months post -operation.However, operation can not improve the life quality at 6 months compared to the conservative treatment.Decompressive surgery undertaken within 48 h of stroke onset in patients younger than 60 years may reduce the mortality and increase the number of patients with a favorable outcome.
