不同时机行去骨瓣减压加颞肌粘贴术治疗急性大脑中动脉区梗死效果的比较

目的探讨不同手术时机去骨瓣减压加颞肌粘贴术对急性大脑中动脉系脑梗死的疗效。方法对25例急性大脑中动脉脑梗死病人行开颅去骨瓣减压、加带血管蒂颞肌肌瓣粘附术，并观察不同手术时机的治疗效果。结果25例病例中生存18例，死亡7例，死亡率28％。早期手术组14例死亡2例。死亡率为14．3％：晚期手术组11例死亡5例，死亡率为45．5％；早期手术明显降低了死亡率（P〈0．01）。生存者术后半年Barthel Index评分早期手术组明显优于晚期手术组（P〈0.05）。结论对于急性大脑中动脉脑梗死，早期行开颅去骨瓣减压、加带血管蒂颞肌肌瓣粘附术，可迅速缓解颅内高压、促进神经功能恢复、减少死亡率．并能改善生存质量。

Effective comparison between different timing on decompressive craniectomy with temporal muscuseular sticking for the teatment of acute infarction of middle cerebral arterial area

Objective To evaluate the effects of decompressive craniectomy with temporal muscle sticking for the treatment of acute middle cerebral artery infarction (MCAI) in different time. Methods 25 patients with acute MCAI were treated by decompressive craniectomy with temporal muscle sticking in different time. Therapeutical effect of different surgical time were observed. Results 18 of 25 patients survived, 7 died (28%). The mortality rate were 14.3%(2/14) and 45.5%(5/11) in early surgery group and late surgery,respectively(P<0.01).Barthel index score after six months of early surgery group was better than that of late surgery group(P<0.05).Conclusion Decompressive craniectomy with temporal muscle sticking could elevate the survival rate of MCAI and increase the recovery rate.Furthermore, the operation should be done as early as possible after the confirmation of cerebral herniation.