【摘要】 目的 探讨微创抽吸坏死脑组织治疗老年重症大脑半球大面积梗死(LHI)患者的疗效和安全性。方法 60例老年重症LHI患者分别采用定向置管抽吸坏死脑组织治疗(抽吸组，32例)和保守治疗(保守组，28例)。比较两组近、远期疗效和并发症发生率。结果 保守组发病1周内脑疝发生率和治疗1个月内病死率均高于抽吸组(62.5%vs.14.3%和71.9%vs.10.7%)(P<0.01),两组治疗1个月内颅内血肿和颅内感染发生率差异无统计学意义(P>0.05)。治疗6个月后，保守组病死率高于抽吸组(78.1%vs.17.9%)(P<0.01),非重残生存率[改良Rankin量表(mRS)评分0～4分]低于抽吸组(12.5%vs.57.1%)(P<0.01),结局良好率(mRS评分0～3分)稍低于抽吸组(3.1%vs.21.4%)(P>0.05)。结论 微创抽吸坏死脑组织可以降低老年重症LHI患者的病死率，改善预后，且安全性好。更多还原

【Abstract】 Objective To explore the efficacy and safety of minimally invasive aspiration of the necrotic brain tissues in the treatment of elderly patients with severe large hemispheric infarction.Methods Sixty elderly patients with severe large hemispheric infarction were treated with directional catheter aspiration of the necrotic brain tissues(group A,32 cases) and conservative treatment(group C,28 cases).The short-term and long-term efficacy and complication rate were compared between the two groups.Results The incidence of early cerebral hernia within 1 week of onset and the mortality within 1 month of treatment in group C were higher than those in group A(62.5% vs.14.3% and 71.9% vs.10.7%)(P<0.01).There was no significant difference in the incidence of intracranial hematoma and infection between the two groups within 1 month of treatment(P>0.05).Compared with group A after 6 months of treatment, group C had higher mortality(78.1% vs.17.9%)(P<0.01),lower survival rate without severe disability(modified Rankin scale 0-4 points)(12.5% vs.57.1%)(P<0.01),and slightly lower good outcome rate(modified Rankin scale 0-3 points)(3.1% vs.21.4%)(P>0.05).Conclusion Minimally invasive aspiration of the necrotic brain tissues can reduce the mortality and improve the prognosis of elderly patients with severe large hemispheric infarction.更多还原