内外减压并颞肌贴附手术治疗大面积脑梗死的疗效分析.docVIP

内外减压并颞肌贴附手术治疗大面积脑梗死的疗效分析 【摘要】 目的 探讨大骨瓣减压及内减压并颞肌贴附治疗急性大面积脑梗死的疗效。方法 回顾分析XX医院五年来收治的大面积脑梗死患者56例，采用标准大骨瓣减压及内减压治疗并颞肌贴附的24例，单纯去大骨瓣减压的16例，保守治疗的16例。结果 将三个治疗组治疗结果相对照，结果差异有统计学意义(P0．O5)。结论 急性大面积脑梗死患者通过标准大骨瓣减压并内减压颞肌贴附手术治疗效果明显优于单纯去骨瓣减压即保守治疗者。 【关键词】大面积脑梗死；去骨瓣减压；内减压；颞肌贴附 Inside and outside decompression and temporal muscle attached surgical treatment of large area cerebral infarction curative effect analysis 【 abstract 】 Objective to study large bone flap decompression and internal pressure relief and temporal muscle attached treatment of large area acute cerebral infarction of the curative effect. Methods retrospective analysis the XX city peoples hospital treated in five years of large area cerebral infarction patients 56 patients, the standard big bone flap decompression and inner decompression therapy and temporal muscle attached 24 cases, simple to big bone flap decompression of 16 cases, the conservative treatment of 16 cases. Results will be three treatment group comparing the results, the results (P 0. O5). Conclusion acute large area cerebral infarction patients through the standard big bone flap decompression and inside decompression temporalis attached surgical treatment effect is obviously superior to the pure to bone flap decompression is the conservative treatment. 【 key words 】 large area cerebral infarction; Boneless disc decompression; Inside decompression; Temporalis attached 脑卒中已成为人类的第二大死亡原因，而其中高达10%的缺血性脑卒中是幕上大脑半球的大面积脑梗死[1]，此类病人的死亡率高达80 %。已有文献报道标准大骨瓣开颅减压手术治疗大面积脑梗死能有效降低颅内压、改善脑灌注、阻止脑缺血性损害，从而改善病人的预后[2]。为降低死亡率、提高患者生存率及生存质量，本研究探讨大骨瓣减压及内减压并颞肌贴附治疗急性大面积脑梗死的疗效。作者收集本院近5年收治大面积脑梗死56例，分别采取去大骨瓣减压+患侧额颞极切除术并颞肌贴附、仅行去大骨瓣减压术及保守治疗(均为家属不愿手术治疗)。三种治疗方法所取得的结果显著不同，现报告如下。 1 资料与方法 1.1 病例选择：所有病例均系住院病例，(1)头颅CT见大面积脑梗死，即大脑中动脉(MCA)区梗塞或大脑中动脉(MCA)+大脑前动脉(ACA)／大脑后动脉(PCA)区梗塞；中线结构向对侧移位5mm，患侧侧脑室及基底池受压；(2)存在意识障碍；(3)排除病例：①年龄大于80岁；②出血性脑梗死 ；③有心梗、心衰、慢阻肺、肾衰等基础疾病；④糖尿病昏迷；⑤存在颅内压占位性病变可能；⑥有脑梗塞或脑出血后遗症；⑦ 脑疝晚期：双瞳孔散大、对光反射消失、眼球固定、生命体征不稳定。将符合条件的56例病人按是否签字同意手术治疗分为手术组和保守治疗组。 1.2 一般资料：手术组病例共40例，男性16例、女性24例，