内科保守治疗与不同手术时机去骨瓣减压治疗大面积脑梗死的对比研究

摘要

目的：对比内科保守治疗与不同手术时机去骨瓣减压手术治疗大面积梗死的临床效果。方法选取我院收治的60例急性大面积梗死患者，根据治疗情况及手术时机的不同，分为A组（内科保守治疗）、B组（脑疝发生后行去骨瓣减压手术）、C组（脑疝发生前行去骨瓣减压手术）各20例。比较3组治疗后NIHSS、GCS、BI、mRS评分、功能恢复状况、病死率及预后情况。结果与治疗前相比，3组治疗后1个月NIHSS评分均明显下降（P＜0.05），且C组下降幅度更大，3组比较差异有统计学意义（P＜0.05）；3组治疗后GCS、BI及mRS评分比较差异均有统计学意义（P＜0.05），C组GCS及BI评分最高，mRS评分最低。治疗后6个月，3组病死率、功能恢复状况及预后比较差异均有统计学意义（P＜0.05）。讨论去骨瓣减压术治疗大面积脑梗死的疗效及短期预后情况显著优于内科保守治疗，且脑疝前期实施手术有利于患者生存率的提高及功能恢复、预后情况的改善。%Objective To compare the clinical efficacy of conservative treatment and decompressive craniectomy in differ‐ent times of operation for massive cerebral infarction patients .Methods Depending on the variable treatment strategy conditions and different times of surgery ,60 cases with acute massive cerebral infarction in our hospital were selected and divided into three groups ,20 cases in each group .Cases in group A were treated with conservative therapy ,cases in group B received de‐compressive craniectomy surgery before the formation of cerebral hernia and the rest in group C underwent decompressive craniectomy surgery after cerebral hernia occurred .Then the NIHSS ,GCS ,BI ,mRS scores as well as recovery status ,mortality and prognosis of the three groups were comparatively analyzed .Results After one‐month treatment ,the NIHSS scores were ob‐viously decreased in all three groups ,especially in group C compared with that before treatment ;and the differences between three groups were significant (P<0 .05) .Furthermore ,the three groups showed statistical differences in terms of GCS ,BI and mRS scores ,and group C got the highest GCS and BI scores and the lowest mRS scores (P<0 .05) .After six‐month treat‐ment ,significant differences were found between three groups as for mortality ,functional recovery and prognosis (P<0 .05) . Conclusion Referring to clinical efficacy and short‐term prognosis ,decompressive craniectomy may take advantages over conser‐vative treatment for the treatment of large cerebral infarction .And carrying out operation at the early stage of cerebral hernia should be beneficial for improving survival rate ,functional recovery and prognosis .