去骨瓣减压术治疗大面积脑梗死的临床研究

目的:通过对21例去骨瓣减压术治疗大面积脑梗死病例的回顾性研究,探讨手术治疗有效性及优化手术的适应证。方法:选择大面积脑梗死的手术病例21例,均予以行额、颞、顶大骨瓣减压术,分别统计入院时、手术前和手术后的GCS、影像学以及远期GOS疗效,并与对照组同期非手术治疗15例进行评价。用spss11.5软件进行统计学分析处理数据。结果:(1)手术组术前平均GCS评分与入院时平均GCS相比较评分显著下降(P<0.01);死亡组病人术前GCS与存活组病人术前GCS评分,2者之间差异显著(P<0.05);(2)根据CT低密度区计算梗死体积,不同的梗死体积在在手术组和非手术组治疗的存活率有显著差异;(3)手术组存活病人手术后7天、手术后3个月、手术后6个月的GOS评分有显著差异。手术组存活病人与非手术组治疗6个月后的GOS评分无显著差异。结论:根据患者的病情进展GCS评分的改变及影像表现,及时行去骨瓣减压术能够提高患者的存活率,改善神经系统功能。

Clinical Research Of Massive Cerebral Ischemia Treated By Decompressive Craniectomy

Objective:To study 21 patients of massive CI treated by decompressive craniectomy,to investigate the effectivity and the indication of the surgery Retrospectively. Methods:Collect the data of 21 patients of massive CI were treated by decompressive craniectomy of frontale,os temporale and os parietale.Compare the GCS,imageing data,and GOS in the time of admission,before and after the operation,and estimate the curative effect by contrast with the control group.Analyze the data by the soft ware of Spss11.5. Results:1.The preoperative GCS descended significantly comparing with the admission GCS(P<0.01); The preoperative GCS of died group and survival group had striking discrepancy(P<0.05);2. To compute the volume of CI by analyzing the low density area in CT,patients with different volume had significant deviation of survival rate in operative group and nonoperative group;4.The GOS of survival patients in operative group 7 days,3 monthes and 6 monthes after the surgery had significant deviation,while the GOS of survival patients 6 monthes after operation had no significant deviation comparing with the nonoperative group with 6 monthes nonoperative treatment. Conclusion:The decompressive craniectomy carried out in time according the GCS and the change in the imaging could improve the survival rate of the massive CI patients as well as improve function of nervous system.