大骨瓣减压术抢救恶性大脑中动脉梗塞疗效分析

目的　总结大骨瓣减压术抢救恶性大脑中动脉梗塞 (mMCAI)的临床经验。方法　总结我院经头颅CT证实并进行大骨瓣减压术的 16例mMCAI患者的临床资料、辅助检查、治疗等 ,以分析手术时机及其他因素与预后的相关性。结果　死亡 6例 (6 / 16 )。死亡和存活患者的中线结构移位的中位数分别为 10 .5mm和 7mm ,手术距脑疝的时间中位数分别为 15 .5h和 4h。手术前加强脱水后瞳孔一度回缩的患者有 7例 ,其中 6例存活。手术前 12h内TCD检查示MCA主干闭塞的 3例患者均死亡 ,部分再通的 5例患者全部存活。 3个月时存活患者BI评分 ,仅有 1例严重残疾。结论　大骨瓣减压术治疗mMCAI是重要的救命措施 ,但要把握手术时机 ,术前强力脱水后瞳孔能短时回缩及TCD监测MCA有部分再通的患者预后较好。

Analysis of curative effect of hemicraniectomy in patients with malignant middle cerebral artery infarction.

Objective To analyze the clinical experience of hemicraniectomy in patient with malignant middle cerebral artery infarction(mMCAI). Methods From January, 1998 to September, 2002, a cohort of 16 patients with mMCAI was performed hemicraniectomy. Midline shift was measured on CT at the septum pellucidum level. Initial clinical presentation was assessed by the Canadian Neurological Scale (CNS) and the Glasgow Coma Scale (GCS).All patients were reexamined 3months after surgical decompression, with the clinical evaluation graded according to the modified Rankin Scale (mRS) and Barthel Index (BI).We analyzed the influence of the time between surgery and the occurrence of clinical signs of herniation to the prognosis.Results In total, 6 patients died. The median of the midline shift in death and survival patients was 10.5mm and 7mm. The median time between surgery and the occurrence of clinical signs of herniation was 15.5h and 4h. In the 7 patients who's dilated pupil can contract temporarily after reinforce osmotherpeutics, 6 patients survival.10 patients was given TCD examination during the 12 hours before decompression, 3 patients who had MCA occlusion all died, and 5 patients who had partial recanalization all survival. Only one of all survival suffered severe disability. Conclusions Hemicraniectomy is a life saving maneuver, but to grasp the opportunity is difficult, dilated pupil cancontract temporarily after reinforce osmotherpeutics and TCD examination indicate partial recanalization may be have better prognosis.