去骨瓣减压术治疗26例大面积脑梗死

目的 探讨去骨瓣减压术治疗大面积脑梗死的临床疗效.方法 对我院经CT及MRI证实的26例大面积脑梗死患者行标准去骨瓣减压术,分析手术的临床疗效及影响因素.结果 本组患者存活21例,半年存活率80.76%,死亡5例,病死率为19.23%.结论 去骨瓣减压术是治疗大面积脑梗死的重要措施,关键是把握手术时机.     

大骨瓣减压术治疗大面积脑梗死临床分析

目的探讨大骨瓣减压术治疗大面积脑梗死的手术指征、手术方法和治疗效果。方法对本院大骨瓣减压术治疗的35例大面积脑梗死患者的临床资料进行回顾性分析。结果本组35例全部存活,功能均有不同程度的恢复。结论大骨瓣减压术可明显降低患者病死率、致残率,改善患者的预后。     

中西医结合治疗大面积脑梗死的疗效观察

目的观察大骨瓣开颅减压术联合吡拉西坦注射液治疗大面积脑梗死的疗效。方法将158例大面积脑梗死患者随机分为治疗组86例和对照组72例。对照组给予大骨瓣开颅减压术治疗,治疗组在此基础上给予吡拉西坦注射液治疗,1个疗程后观察两组疗效。结果治疗组总有效率为94.18%高于对照组的73.61%,差异有统计学意义(P0.05)。结论大骨瓣开颅减压术联合吡拉西坦注射液治疗大面积脑梗死,疗效显著,是临床上治疗大面积脑梗死的首选方法,显著提高了患者术后的生存率及生活质量,值得在临床上推广与应用。     

双侧额颞平衡改良大骨瓣减压术与常规去骨瓣减压术在大面积脑梗死中的应用对比

目的探讨分别采用双侧额颞平衡改良大骨瓣减压术与常规去骨瓣减压术在治疗大面积脑梗死时的应用效果及临床疗效。方法选取符合手术指征的大面积脑梗死病人92例作为受试者,按随机数字表法分为两组。对照组46例采用常规去骨瓣减压术治疗,治疗组46例采用双额颞平衡改良大骨瓣减压术对病情控制。治疗结束后,比较治疗前后两组美国国立研究院卒中量表(NIHSS)、Bathel指数、格拉斯哥昏迷评分(GCS)评分、不良反应发生情况及临床疗效的变化。结果与治疗前相比,治疗组治疗后病人Bathel指数、GCS评分水平升高,NIHSS水平下降(P0.05),临床疗效改善,不良反应发生率得到控制;与对照组比较,治疗组总有效率较高,Bathel指数、GCS评分水平较高,NIHSS水平较低(P0.05),不良反应发生率较低且明显得到控制,安全性较高。结论双侧额颞平衡改良大骨瓣减压术的运用能有效提高大面积脑梗死的治疗效果。     

早期去大骨瓣减压术对大面积脑梗死患者的影响

目的探讨早期去大骨瓣减压术对大面积脑梗死患者的影响。方法选取2005年12月—2016年6月恩施市巴东县人民医院收治的大面积脑梗死患者100例,以发病24 h内行去大骨瓣减压术者为早期治疗组(n=31),以发病24 h后行去大骨瓣减压术者为延迟治疗组(n=34),以未行大骨瓣减压术、仅接受保守治疗者为保守治疗组(n=35)。治疗后随访6个月,比较3组患者存活率、语言功能恢复率、肢体运动功能恢复率。结果随访6个月,早期治疗组患者存活率、语言功能恢复率、肢体运动功能恢复率高于延迟治疗组、保守治疗组,延迟治疗组患者存活率、语言功能恢复率、肢体运动功能恢复率高于保守治疗组(P<0.05)。结论早期去大骨瓣减压术能有效促进大面积脑梗死患者语言、肢体运动功能恢复,提高患者生存率。     

急性症状性颈内动脉闭塞的血管内治疗2例

急性症状性颈内动脉闭塞多发生于老年人,病情较重,多伴有昏迷,部分病人由于出现大面积脑梗死、脑水肿,导致脑疝而行大骨瓣减压术,预后差.传统的内科治疗效果不佳,我们应用血管内介入治疗2例,取得良好疗效.     

去骨瓣减压术治疗大面积脑梗死的临床指征分析

目的探讨去骨瓣减压术治疗大面积脑梗死的手术指征、手术时机和治疗效果。方法对2012年1～6月天津市环湖医院手术治疗的17例大面积脑梗死患者的临床资料进行回顾性分析。结果本组患者17例,死亡3例。在随访的14例患者中,13例恢复满意,GCS、BI和MRS评分均较术前有显著提高。结论去骨瓣减压术不仅可明显降低大面积脑梗死患者的病死率,而且可以获得较好的功能预后。对大面积脑梗死的患者,经积极内科治疗无效者,在正确掌握适应证的前提下,应尽早行去骨瓣减压术,以便得到更积极的治疗。     

早期大骨瓣减压治疗急性大面积脑梗死疗效分析

2002年2月～2007年9月，我院对30例急性大面积脑梗死（CI）患者行大骨瓣减压手术治疗，疗效良好。现报告如下。     

改良预减压标准大骨瓣减压术治疗创伤性急性硬膜下血肿合并脑疝患者的临床疗效研究

目的探讨改良预减压标准大骨瓣减压术治疗创伤性急性硬膜下血肿合并脑疝患者的临床疗效。方法选取2009年7月—2014年6月东南大学附属徐州医院收治的创伤性急性硬膜下血肿合并脑疝患者127例,根据选择的手术方式,分为对照组54例和观察组73例。观察组患者行改良预减压标准大骨瓣减压术,在行标准大骨瓣减压术前开减压窗口进行减压操作;对照组患者常规行标准大骨瓣减压术。记录两组患者术后3个月的格拉斯哥预后量表(GOS)评分。结果观察组患者的平均GOS评分高于对照组,临床疗效优于对照组(P0.05)。结论改良预减压标准大骨瓣减压术治疗创伤性急性硬膜下血肿的临床疗效确切,有利于患者预后。     

大面积脑梗死26例诊治体会

目的总结分析大面积脑梗死的临床特点及诊治方法。方法回顾性分析26例大面积脑梗死患者的临床资料,分析其临床表现,CT检查结果及治疗效果。结果 26例大面积脑梗死患者中,内科保守治疗20例,转神经外科行去骨瓣减压术治疗6例;存活18例,死亡8例,存活者均行系统康复治疗,出院后随访6个月,GOS评分结果显示,恢复良好7例,重残3例,中残7例,植物生存1例。结论及时诊断和治疗对改善大面积脑梗死患者预后具有积极意义。     

大面积脑梗死患者脑疝及预后的影响因素研究

背景多种因素与脑梗死患者死亡有关,但目前关于大面积脑梗死患者脑疝及其死亡影响因素的研究报道较少见。目的探讨大面积脑梗死患者脑疝及预后的影响因素。方法选取2014-2018年在西南医科大学附属医院神经内科住院治疗的大面积脑梗死患者172例,根据脑疝发生情况分为脑疝组(n=61)和非脑疝组(n=111);随访期间失访14例,根据随访结果分为死亡组(n=106)和存活组(n=52)。比较脑疝组与非脑疝组、死亡组与存活组患者一般资料、实验室检查指标、神经功能;大面积脑梗死患者脑疝的影响因素分析采用多因素Logistic回归分析,大面积脑梗死患者预后的影响因素分析采用Cox比例风险回归模型。结果 (1)脑疝组与非脑疝组患者年龄,性别,高血压、糖尿病、心房颤动、冠心病、短暂性脑缺血发作(TIA)/脑梗死病史,吸烟史,饮酒史,体温,收缩压,舒张压,白细胞计数,中性粒细胞计数,总胆固醇,三酰甘油,空腹血糖,高敏肌钙蛋白T,N末端脑钠肽前体(NT-proBNP),格拉斯哥昏迷量表(GCS)评分,心功能不全、头痛、呕吐、双眼凝视、意识障碍、肺部感染、心肌梗死发生率,行溶栓治疗及取栓治疗者所占比例比较,差异无统计学意义(P>0.05);脑疝组患者行去骨板减压术者所占比例、美国国立卫生研究院卒中量表(NIHSS)评分高于非脑疝组,且两组出血性转化发生情况比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、脑实质出血是大面积脑梗死患者脑疝的影响因素(P<0.05)。(2)死亡组与存活组患者年龄,性别,高血压、糖尿病、心房颤动、冠心病、TIA/脑梗死病史,吸烟史,饮酒史,体温,舒张压,总胆固醇,三酰甘油,心功能不全、头痛、呕吐、双眼凝视、意识障碍、肺部感染、心肌梗死发生率,出血性转化情况,行溶栓治疗及取栓治疗者所占比例比较,差异无统计学意义(P>0.05);存活组患者收缩压、白细胞计数、中性粒细胞计数、空腹血糖、高敏肌钙蛋白T、NT-proBNP、NIHSS评分及脑疝发生率低于死亡组,行去骨瓣减压术者所占比例及CGS评分高于死亡组(P<0.05)。Cox比例风险回归模型分析结果显示,心肌梗死、脑疝、去骨瓣减压术、NIHSS评分是大面积脑梗死患者预后的影响因素(P<0.05)。结论年龄小、脑实质出血是大面积脑梗死患者脑疝的影响因素,而心肌梗死、脑疝、去骨瓣减压术、NIHSS评分是大面积脑梗死患者预后的影响因素。     

手术治疗高分级动脉瘤性蛛网膜下腔出血的临床疗效

目的探讨高分级动脉瘤性蛛网膜下腔出血（aSAH）的手术疗效。方法回顾性分析2001—2008年复旦大学附属华山医院神经外科经手术治疗的27例（动脉瘤28个）Hunt—HessIV、V级aSAH患者的临床资料。其中入院时Hunt—HessIV级23例,V级4例。行动脉瘤夹闭27个,孤立和血管重建1个。术中行第三脑室造瘘或脑室外引流13例,去骨瓣减压14例。分析影响患者预后的因素。结果（职7例中,出院时死亡8例,死亡原因为术中出血导致术后脑梗死2例;术后严重的血管痉挛导致大面积脑梗死6例。出院时残留偏侧肢体肌力下降6例,定向障碍5例,意识不清4例。②术后出现肺部感染19例,电解质紊乱20例,心律失常6例。③平均随访47个月（15～96个月）。随访期死亡2例。总体疗效恢复良好率为51．9％（14／27）,预后差为11．1％（3／27）,病死率为37．0％（10／27）。⑤在年龄、Hunt—Hess分级、术前格拉斯哥昏迷评分、手术距离出血的时间及是否合并急性脑积水的因素中,影响患者的预后,且差异有统计学意义的为术前格拉斯哥昏迷评分。结论高级别aSAH患者预后与多因素有关。根据患者病情选择合理的治疗方式,可以改善高分级aSAH患者预后。     

Postoperativer Verlauf nach akutem Subduralh?matom im h?heren Lebensalter

Aim

The goal of the study was to analyze the short-term outcome after surgical treatment of acute subdural hematomas in two treatment groups in a patient population >65?years. Whether there are disadvantages from invasive treatment or whether advantages can be achieved with the less invasive treatment has not been previously examined in a prospective study.

Methods

A prospective, nonrandomized study of 50?patients >65?years with acute traumatic subdural hematoma was performed, comparing the short-term outcome after two different primary surgical procedures: limited craniotomy (group A, n=25) and large decompressive craniectomy (group B, n=25).

Results

There were no differences of hematoma volume, degree of midline structure shift, and time from trauma to operation between the two groups. Initial Glasgow coma scale and short-term outcome after 4?weeks measured by the Glasgow outcome score in both groups showed no significant differences.

Conclusion

No significant differences between short-term outcome after limited craniotomy versus large decompressive craniectomy were found for patients >65?years, and the results indicate that decompressive craniectomy can be accepted as a surgical treatment option for acute traumatic subdural hematoma even in elderly patients.     

Paradoxical Herniation After Unilateral Decompressive Craniectomy Predicts Better Patient Survival: A Retrospective Analysis of 429 Cases

Paradoxical herniation (PH) is a life-threatening emergency after decompressive craniectomy. In the current study, we examined patient survival in patients who developed PH after decompressive craniectomy versus those who did not. Risk factors for, and management of, PH were also analyzed.This retrospective analysis included 429 consecutive patients receiving decompressive craniectomy during a period from January 2007 to December 2012. Mortality rate and Glasgow Outcome Scale (GOS) were compared between those who developed PH (n = 13) versus those who did not (n = 416). A stepwise multivariate logistic regression analysis was carried out to examine the risk factors for PH.The overall mortality in the entire sample was 22.8%, with a median follow-up of 6 months. Oddly enough, all 13 patients who developed PH survived beyond 6 months. Glasgow Coma Scale did not differ between the 2 groups upon admission, but GOS was significantly higher in subjects who developed PH. Both the disease type and coma degree were comparable between the 13 PH patients and the remaining 416 patients. In all PH episodes, patients responded to emergency treatments that included intravenous hydration, cerebral spinal fluid drainage discontinuation, and Trendelenburg position. A regression analysis indicated the following independent risk factors for PH: external ventriculostomy, lumbar puncture, and continuous external lumbar drainage.The rate of PH is approximately 3% after decompressive craniectomy. The most intriguing findings of the current study were the 0% mortality in those who developed PH versus 23.6% mortality in those who did not develop PH and significant difference of GOS score at 6-month follow-up between the 2 groups, suggesting that PH after decompressive craniectomy should be managed aggressively. The risk factors for PH include external ventriculostomy, ventriculoperitoneal shunt, lumbar puncture, and continuous external lumbar drainage.     

标准去骨瓣减压与常规去骨瓣减压治疗重型颅脑外伤的对比研究

目的 探讨标准大骨瓣开颅术在治疗重型颅脑损伤中的临床应用价值.方法 选择64例重型颅脑外伤患者,随机均分为观察组和对照组,各32例,对照组使用常规去骨瓣减压术,观察组使用标准去骨瓣减压治疗,比较两组患者术后颅内压变化情况,以及术后6个月随访的预后情况及并发症.结果 观察组术后1、3、7d颅内压均低于对照组同时间段颅内压水平(P＜0.05),观察组经过治疗后预后良好者为16例,对照组仅为7例,观察组预后良好者比率明显大于对照组(P＜0.05),对照组出现术后脑积水和迟发性血肿比率均高于对照组(P＜0.05).结论 标准去骨瓣减压术治疗重症颅脑外伤,相对于常规去骨瓣减压术而言,能更好的降低患者术后颅内压,且术后疗效相对较好,并发症少,是一种值得推广的手术治疗方法.     

尿激酶溶栓治疗急性心肌梗死的疗效观察

目的探讨应用尿激酶溶栓对急性脑梗死进行治疗所取得的临床效果,并对其治疗作用和意义进行分析总结。方法选择我院曾收治的急性心肌梗死患者62例,将其随机分为数量相等的两组,分别作为观察组和对照组,观察组中患者利用尿激酶溶栓来进行治疗,对照组患者利用常规方法来进行治疗。在完成治疗之后对两组患者的治疗效果进行比较分析,主要包括效果、引发症状以及并发症与血管再通率。结果对照组患者中有10例患者溶栓值趋于正常标准化,其标准率为32.3%,观察组中患者有21例的溶栓值趋于正常标准,其标准率为67.7%,两组患者之间存在显著差异;两组患者中的血管再通率分别为80.6%和38.7%,有显著差异存在;观察组中患者的引发症状以及并发症都较少,两组患者之间存在显著差异。结论对于急性心肌梗死患者来说,利用尿激酶溶栓进行治疗能够取得较好的效果,血管再通率较高,不会引发其它症状,所出现的并发症也比较少,比较安全,在临床医学上具有重要的作用和意义,值得在临床上进行推广。     

亚低温对静脉窦血栓形成合并脑病患者脑保护作用的初步研究

目的 初步探讨亚低温辅助治疗对静脉窦血栓形成导致颅内高压合并脑病患者的脑保护效果.方法 回顾性分析14例静脉窦血栓形成颅内高压合并脑病患者的临床资料.所有患者均接受了静脉窦内接触性溶栓结合机械碎栓治疗,同时采用脱水、降颅压等多种药物治疗.对发生脑庙后的6例患者,行开颅清除血肿和（或）单纯去骨瓣减压术.对7例患者（亚低温组）采用亚低温辅助治疗的方法,控制目标肛温在35℃,平均持续（4 ±2）d;对另外7例（非亚低温组）常规控制目标肛温〈 38℃.比较两组患者短期和长期神经系统功能的情况、疾病转归和预后.结果 ①降温24 h时,亚低温组的肛温平均为（35.2±0.9）℃,非亚低温组为（37.1±0.5）℃.②亚低温组3例患者存活且恢复良好,3个月格拉斯哥预后评分（GOS）为（27±2.1）分,死亡4例;非亚低温组死亡6例,存活1例,GOS为4分.亚低温组死亡比例为4/7,非亚低温组为6/7,P=0.559.结论 重症静脉窦血栓形成导致颅内高压合并脑病患者的病死率高,亚低温辅助治疗可能具有一定的脑保护作用,从而降低患者的病死率.     

标准外伤大骨瓣开颅联合外侧裂池打开引流治疗额颞顶部重型颅脑损伤的疗效分析

目的探讨采用标准外伤大骨瓣开颅去骨瓣减压联合外侧裂池打开引流术治疗额颞顶部重型颅脑损伤患者的效果。方法回顾性分析该科采用标准外伤大骨瓣开颅去骨瓣减压联合外侧裂池打开引流术治疗109例额颞顶部重型颅脑损伤患者的临床资料,并进行GOS疗效评定。结果随访6个月,存活93例（85．3％）,良好41例（37．6％）,中残32例（29．4％）,重残14例（12．8％）,植物生存6例（5．5％）。死亡16例（14．7％）。结论标准外伤大骨瓣开颅去骨瓣减压联合外侧裂池打开引流术治疗额颞顶部重型颅脑损伤患者疗效确切,可降低病死率与减少术后并发症,提高患者生存质量。     

Malignant cerebral infarction secondary to internal carotid injury in closed head trauma: good outcome with aggressive treatment--a case report

A 25-year-old male patient in whom occlusion of the internal carotid artery developed secondary to a skull base fracture is presented. The diagnosis of internal carotid artery occlusion was reached 12 hours after the admission and 17 hours after the injury. The patient was initially treated for ischemic edema and when the patient showed signs of cerebral herniation, decompressive craniectomy was necessary. The outcome was good. The clinical and radiologic characteristics of internal carotid artery occlusion in closed head injury are highlighted and treatment options are reviewed in light of pertinent literature.     

Right ventricular dysfunction and surgical outcome in postinfarction ventricular septal defect

The data of 50 consecutive patients treated for postinfarctionventricular septal defect were reviewed. Cardiac catheterizationwas carried out in all patients and surgical repair was undertakenin 32 patients. The main factors affecting surgical outcome were the site ofinfarction and the extent of right ventricular damage. Anteriormyocardial infarction carried a better hospital survival ratethan inferior infarction (67 and 31%, respectively). Poor rightventricular free wall contraction, present in 44% of anteriorinfarctions and 71% of inferior infarctions carried a high mortality.Eighty per cent (12/15) of patients with good right ventricularcontraction survived operation compared to only 24% (4/17) ofpatients with poor right ventricular contraction. Surgery within 24 h to 14 days of infarction carried a survivalrate of 50% (7/14), similar to that in patients operated onmore than two weeks following infarction (9/18). Seventeen out of 18 patients who did not undergo surgery eitherdied suddenly before scheduled operation or were consideredtoo poor a surgical risk. Of these, 12 patients died withinone week of infarction and five patients survived between twoweeks and three months. Early surgical repair should therefore be considered in allpatients with postinfarction ventricular septal defect, theprognosis in patients with good right ventricular contractionbeing excellent.