【摘要】 目的探讨大骨瓣减压手术对大面积脑梗死患者的临床效果。方法将2010年3月～2011年5月入院的62例符合标准的大面积脑梗死患者根据家属是否同意手术分成手术组和保守治疗组,其中保守组28例,保守组进行常规标准的内科治疗;手术组34例,在常规治疗上加用大骨瓣减压手术治疗,都在重症监护室护理,后随访6个月,将两组的NIHSS、ADL评分、死亡率和致残率、住院时间、ICU时间和住院费用等进行比较。结果治疗后随访6个月,手术组的死亡率(20.6%)显著低于保守组(60.6%),P﹤0.05;手术组恢复正常生活能自理率(14.7%)和轻度致残率(47.1%)均显著高于保守组,P﹤0.05;两组患者治疗后的NIHSS和ADL评分差异有统计学意义,P﹤0.05;手术组的平均住院时间要显著长于保守组,P﹤0.05;平均住院费用极显著高于保守组,P﹤0.01;平均ICU时间差异无统计学意义,P﹥0.05。结论大骨瓣减压手术可降低大面积脑梗死患者的生存率,但是否提高患者术后生存质量尚存争议,同是相对费用较高。更多还原

【Abstract】 OBJECTIVE To investigate the clinical effect for hemicraniectomy surgery in the treatment of massive cerebral infarction.METHODS 62 patients with massive cerebral infarction were collected from March 2010 to May 2011,and they were divided into the surgery group and the conservative treatment group according to their agreement.The conservative treatment group had 28 cases,and they received the conventional medical treatment.The surgery group had 34 patients,they received hemicraniectomy surgery and conventional therapy treatment.All the patients were treated in the intensive care unit care.All of them were followed up for 6 months.the NIHSS,ADL score,mortality and morbidity,hospital time,ICU time and hospital costs were compared between the two groups.RESULTS After treatment for 6 months,the mortality of the surgical group(20.6%)was significantly lower than the conservative group(60.6%)(P﹤0.05).The rate of restoring normal life in the surgery group was 14.7%,and the mild disability rate(47.1%)were significantly higher than the conservative group(P﹤0.05).The NIHSS score and ADL score had significant difference in the two groups after treatment(P﹤0.05).The average hospitalization time in the surgical group was significantly longer than that of the conservative group(P﹤0.05).The average hospital cost was significantly higher than that of the conservative group(P﹤0.01).The ICU time did not show significant difference,P﹥0.05.CONCLUSION The hemicraniectomy surgery can reduce the survival rate of patients with massive cerebral infarction.However,the quality of life in patients with surgery is still controversial,and the cost is relatively high.更多还原