【摘要】 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。更多还原

【Abstract】 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.更多还原