标准大骨瓣减压治疗大面积脑梗死探讨

目的：探讨标准大骨瓣减压治疗大面积脑梗死的手术技巧、手术时机和预后因素。方法：回顾性分析9例标准大骨瓣减压治疗大面积脑梗死患者的临床资料,总结年龄、手术距发病时间、脑梗死部位、术前格拉斯哥昏迷评分（GCS评分）、术后3个月和6个月M RS评分及B arthe l生活指数（B I）预后评价。结果：9例患者发病距手术时间平均（59.67±15.63）h。左侧大脑中动脉（LM CA）供血区梗死3例,右侧大脑中动脉（RM CA）区梗死3例,左侧大脑中动脉区加前动脉区（LM CA＋LACA）梗死3例。入院时GCS评分平均（11.78±2.69）分,手术前GCS评分平均（8.22±2.07）分。2例（22.2%）术后死亡,存活7例（77.8%）。术后3个月随访M RS评分,4分（重残）4例,3分（中残）3例。B I评分：55分4例,65分2例,75分1例;术后6个月M RS评分：4分1例,3分5例,2分（轻残）1例;存活7例患者的B l评分：85分1例,70分3例,75分2例,65分1例。结论：标准大骨瓣减压是治疗大面积脑梗死的有效方法。

To dicuss the decompression by standard for treatment of large ischemic cerebral infarction

Objective：To probe into the skills and time for decompression operation and predictors associated with outcomes of decompression by standard large craniectmy to treat large ischemic cerebral infarction.Methods：Reviewing and analyzing 9 patients with large ischemic cerebral infarction who underwent decompression by standard large craniectomy.Summarizing the predictors including patients′ age,time and score of GCS before the operation.The patients were followed 3 and 6 months after the operation,to evaluate the prognosis according the score of the MRS and barthel index（BI）.Results：The average time before the operation is（59.67±15.63） hours.The ischemic areas of 3 cases locate on the territory supplied by the right middle cerebral artery,those of 3 cases located on that by the left middle cerebral artery,and those of 3 cases locate on that by the left middle cerebral artery and anterior cerebral artery.The average score of GCS for patients at admission is 11.78±2.69,that before the operation is 8.22±2.07.Two cases who account for 22.2% of the nine patients died after the operation,7 cases were survival.Three months after the operation,4 cases got 4 scores,3 cases got 3 scores according to the MRS assessment.4 cases got 55 scores,2 cases got 65 scores,1 case got 75 scores according to the BI.Six months after the operation,according to the MRS assessment 1 cases got 4 scores,5 cases got 3 scores,1 cases got 2 scores.According to the BI,3 cases got 70 scores,2 cases got 75 scores,1 case got 65 scores,1 case got 85 scores.Conclusion：The decompression by standard craniectomy is an effective way to treat the large ischemic cerebral infarction.