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目的探讨早期行标准大骨瓣开颅减压治疗大面积脑梗塞可否提高病人的疗效、降低死亡率。方法51例因一侧完全性的大脑中动脉供血区脑梗塞而施行了标准大骨瓣开颅减压手术病人的资料。术前以全国第四次脑血管病学术会议通过的“脑卒中患者临床神经功能缺损程度评分标准”及the Glasgow Coma Scale(GCS)进行评估。以发病至手术的时间为界将病人分为两组,即早期手术组和晚期手术组。所有生存者在术后3个月按Barthel Index(BI)进行神经功能评估。结果晚期手术组病人从发病到手术的平均时间是51h,而早期组为28h。早期组死亡率为14.3%(3/21),而晚期组为26.7%(8/30)。术前出现颞叶钩回疝并有单侧瞳孔散大固定者,在晚期治疗组为80%(24/30),而早期手术组仅为13.5%(3/21)(P<0.001);术后3个月以BI评估病人的神经功能情况是早期组为69.8分,晚期组为61.7分(P<0.05)。结论早期施行标准大骨瓣开颅减压治疗大面积脑梗塞能显著提高病人的生存率及生存质量。
Objective To investigate whether standard large craniotomy decompression can improve the curative effect of patients and reduce the mortality rate in large area cerebral infarction. Methods A total of 51 patients underwent standard craniotomy decompression surgery due to cerebral infarction on one side of the complete middle cerebral artery. Preoperative assessment of the “standard score of clinical neurological deficit in stroke patients” and the Glasgow Coma Scale (GCS) were approved by the Fourth National Cerebrovascular Disease Symposium. Patients were divided into two groups based on the time from onset to surgery, namely, the early operation group and the late operation group. All survivors were evaluated for neurological function by Barthel Index (BI) 3 months after surgery. Results The average time from onset to surgery in patients in the late surgery group was 51 h compared to 28 h in the early group. Mortality in the early group was 14.3% (3/21) compared with 26.7% (8/30) in the late group. There were 80 cases (24/30) in the treatment group and 13.5% (3/21) cases in the early operation group (P <0.001). The neurological function of patients evaluated by BI at 3 months after operation was 69.8 points in the early stage and 61.7 points in the late stage (P <0.05). Conclusion The early implementation of standard craniotomy decompression of large area cerebral infarction can significantly improve the patient’s survival rate and quality of life.