早期大骨瓣减压术治疗大面积脑梗死

目的探讨大面积脑梗死早期大骨瓣减压术的手术适应证、手术时机、手术方法及影响预后的因素。方法2002年2月至2008年2月收治23例大面积脑梗死病人，其中外伤性4例，缺血性脑卒中16例，动脉瘤性蛛网膜下腔出血后脑血管痉挛性3例，均在脑梗死发病后48h内进行大骨瓣减压术治疗。结果术后所有病人均随访6个月～2年，死亡5例（21．7％）。其中60岁以下者，死亡2例（12．5％，2／16）；60岁以上者3例（42．9％，3／7）。脑疝出现前手术20例，死亡3例（15．0％）；脑疝发生后手术3例，死亡2例（66．7％）。植物生存1例、重残8例，轻残生活需照顾者6例，良好3例。结论早期大骨瓣减压术治疗能明显降低大面积脑梗死患者的死亡率，提高其生存质量，脑疝发生前手术治疗效果明显，年龄轻者效果好。

Early Large Decompressive Craniectomy for Massive Cerebral Infarction

Objective To explore the indication, opportunity, and method of neurosurgery for massive cerebral infarction (MCI), and factors influencing the prognosis in the patients with MCI undergoing early large decompressive craniectomy. Methods The clinical data of 23 patients with MCI, who underwent large decompressive craniectomy within 48 hours after MCI from February, 2002 to February, 2008, were analyzed retrospectively. MCI in 4 patients was produced by brain injury, in 16 by cerebral ischemic stroke and in 3 by cerebrovascular spasm after aneurysmal subarachnoid hemorrhage. Results All the patients were followed up from 6 months to 2 years. Of 23 patients, 3 were recovered well, 6 disabled mildly, 8 disabled severely, 1 survived vegetatively and 5 died. Conclusions Early large decompressive craniectomy may reduce mortality and improve the life quality of survivors in the patients with MCI.