【摘要】 目的评价早期大骨瓣减压治疗大面积脑梗死的效果,分析影响预后的因素。方法选择2010年12月~2013年11月连云港市东方医院大面积脑梗死60例为研究对象,对所有患者进行患侧大骨瓣减压和硬脑膜成形术。在随访的12个月中,应用巴氏指数(BI)及格拉斯哥预后分级(GOS)对患者进行神经功能的评价。结果 30 d病死率为20%(12例),12个月病死率为26.6%(16例)。与病死率有关的因素包括年龄≥60岁、脑疝征象、手术时间超过24 h(OR=42.20、0.10、17.80,P=0.0068、0.0499、0.0463)。平均GOS为(3.3±1.7)分,平均BI为(65.1±40.1),29例(65.9%)患者效果良好(BI≥60)。结论年龄小于60岁的大面积脑梗死患者采用大骨瓣减压术有较好的疗效,手术时间应小于24 h。患者年龄、手术时机和脑疝形成是影响病死率和功能恢复预后的主要因素。更多还原

【Abstract】 Objective To evaluate the effects of early decompressive hemicraniectomy in massive cerebral infarction and analyze the prognostic factors. Methods 60 cases of massive cerebral infarction from December 2010 to November2013 in Lianyungang Oriental Hospital were selected as the research object, all patients were given a large ipsilateral craniectomy and duroplasty for decompression. Functional outcome of patients were evaluated using the Barthel index(BI) and the Glasgow outcome scale(GOS) at follow-up 12 months later. Results 30 d mortality was 20%(12 cases)and 12 month mortality was 26.6%. The factors associated with higher mortality were age ≥60 years, presence of signs indicating clinical herniation, and treatment more than 24 h after ictus(OR =42.20, 0.10, 17.80; P =0.0068, 0.0499,0.0463). The mean GOS score was(3.3±1.7) scores, the mean Barthel index was(65.1 ±40.1), 29 cases(65.9%) of patients had a favourable outcome(BI≥60). Conclusion Decompressive hemicraniectomy should be performed in patients younger than 60 years within 24 h of ictus before clinical signs of herniation develop. Age, timing of surgery and clinical signs of herniation are prognostic factors for mortality and functional outcome.更多还原