目的探讨急性大面积脑梗死早期康复的临床意义。方法 2006年1月至2010年10月收治的68例大面积脑梗死病例。结果 68例中存活51例,存活率75.0%;死亡17例,死亡率25.0%,但存活的51例患者中随机组21例,对照组30例,对照组与随机组患者神经功能受损程度均明显下降,但随机组下降更为明显,两组比较差异具有统计学意义(P<0.01)。结论大面积脑梗死患者多数有高血压、心脏病史,有些有缺血性脑血管病发作史、糖尿病史。这些因素可导致血管壁损害,血液成分及血液动力学改变,尤其是房颤导致心脏内附壁栓子的不断形成,一旦大的栓子脱落,进入脑血管,便可导致本病的发生。由于梗塞面积大,侧枝循环代偿能力差,常造成大量脑细胞短期内变性、坏死,从而使大面积脑梗死患者突然发病,急性期内病情重。本组资料显示,全部病例有单侧或双侧的肢体瘫痪,这也是大面积脑梗死的主要临床特征之一。相当一部分大面积脑梗死患者早期头颅CT24h内不能发现病灶,因此应紧密结合该病的主要特征,并于24h后再次复查头部CT,尽早作出正确诊断。大面积脑梗死病情凶险,重在预防。一旦患病,应早期诊断,急性期注意降低颅内压,采取综合疗法,尽早进行早期康复治疗及干预,积极处理并发症、基础病,对降低死亡率有重要意义。临床医生应该用动态的、全面的观点看待它。 Objective To investigate the clinical significance of early rehabilitation of acute large area cerebral infarction. Methods From January 2006 to October 2010, 68 cases of large area cerebral infarction were treated. Results Of the 68 cases, 51 survived and the survival rate was 75.0%. There were 17 deaths and 25.0% mortality. Of the 51 survivors, 21 were randomized and 30 were controlled. In the control and randomized groups, the degree of neurological impairment Were significantly decreased, but the more obvious decline in the random group, the difference between the two groups was statistically significant (P <0.01). Conclusion Most of patients with large area cerebral infarction have hypertension, history of heart disease, some history of ischemic cerebrovascular disease and history of diabetes mellitus. These factors can lead to vascular wall damage, changes in blood components and hemodynamics, especially in patients with atrial fibrillation atrial appendage emboli continue to form, once the large emboli fall into the cerebrovascular, can lead to the occurrence of the disease. Due to large infarct size, collateral circulation compensatory ability is poor, often resulting in a large number of brain cells in the short term degeneration and necrosis, so that sudden onset of large area cerebral infarction, severe illness in the acute phase. This group of data show that all cases of unilateral or bilateral limb paralysis, which is one of the major clinical features of large-area cerebral infarction. A considerable portion of large infarcts in patients with early cranial CT24h lesions can not be found, and therefore should be closely linked to the main features of the disease, and 24 hours after the review of the head CT again, make the correct diagnosis as soon as possible. Large areas of cerebral infarction dangerous, focusing on prevention. Once the illness, should be diagnosed early, pay attention to reduce intracranial pressure in acute phase, take comprehensive treatment, early rehabilitation treatment and intervention as soon as possible, and actively handle complications, underlying diseases, reduce mortality is important. Clinicians should take a dynamic, comprehensive view of it.