doi:10.19854/j.cnki.1008-2425.2024.03.0010

Abstract

摘要： 目的探讨去骨瓣减压联合失活脑组织清除治疗恶性大脑中动脉梗死(mMCAI)对患者神经功能恢复及并发症的影响。方法采用回顾性研究方法,分析2021年1月～2023年1月邢台市第三医院120例mMCAI患者临床资料,根据120例患者外科治疗方法进行分组,分为研究组(去骨瓣减压+失活脑组织清除,62例)和对照组(单纯去骨瓣减压治疗,58例)。通过比较两组术前、术后14 d时美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷评分(GCS)评分、90 d时Barthel指数、并发症及病死率,探讨去骨瓣减压联合失活脑组织清除治疗mMCAI的应用价值。结果研究组90 d内病死5例(8.06%),对照组病死7例(12.07%),两组90 d内病死率比较,差异无统计学意义(P＞0.05)。两组患者术后14d时NIHSS评分相比术前降低,GCS评分相比术前升高(P＜0.05),两组术后14 d时GCS评分比较,差异无统计学意义(P＞0.05)。研究组术后14d时NIHSS评分低于对照组(P＜0.05),90 d时Barthel指数评分高于对照组(P＜0.05)。研究组90 d内颅内压升高患者少于对照组,脑积水患者多于对照组(P＜0.05)。结论采用去骨瓣减压联合失活脑组织清除治疗mMCAI患者能减少神经功能缺损,改善日常生活能力,且有助于减少颅内压升高,但需要重视脑积水的防治。

关键词: 恶性大脑中动脉梗死, 去骨瓣减压, 失活脑组织清除, 神经功能

CLC Number:

R743

苏建龙, 甄文剑, 孙宇婷, 郝进敏. 去骨瓣减压联合失活脑组织清除治疗恶性大脑中动脉梗死对患者神经功能恢复及并发症的影响[J]. 立体定向和功能性神经外科杂志, 2024, 37(3): 174-177.

References

[1] Moughal S,Trippier S,Al-Mousa A,et al.Strokectomy for malignant middle cerebral artery infarction:experience and meta-analysis of current evidence[J].J Neurol,2022,269(1):149~158.
[2] Tracol C,Vannier S,Hurel C,et al.Predictors of malignant middle cerebral artery infarction after mechanical thrombectomy[J].Rev Neurol(Paris),2020,176(7~8):619~625.
[3] Torbey MT,Bösel J,Rhoney DH,et al.Evidence-based guidelines for the management of large hemispheric infarction:a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine[J].Neurocrit Care,2015,22(1):146~164.
[4] Berge E,Whiteley W,Audebert H,et al.European Stroke Organisation(ESO)guidelines on intravenous thrombolysis for acute ischaemic stroke[J].Eur Stroke J,2021,6(1):I~LXII.
[5] Sehweil SMM,Goncharova ZA.How I do it:decompressive hemicraniectomy supplemented with resection of the temporal pole and tentoriotomy for malignant ischemic infarction in the territory supplied by the middle cerebral artery[J].Acta Neurochir(Wien),2022,164(6):1653~1657.
[6] 陈致远,董成龙,陈茂刚,等.微创抽吸坏死脑组织治疗老年重症大脑半球大面积梗死的临床疗效[J].江苏医药,2022,48(11):1093~1096.
[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666~682.
[8] Kwah LK,Diong J.National institutes of health stroke scale(NIHSS)[J].J Physiother,2014,60(1):61.
[9] Teasdale G,Maas A,Lecky F,et al.The Glasgow Coma Scale at 40 years:standing the test of time[J].Lancet Neurol,2014,13(8):844~854.
[10] 闵瑜,吴媛媛,燕铁斌.改良Barthel指数(简体中文版)量表评定脑卒中患者日常生活活动能力的效度和信度研究[J].中华物理医学与康复杂志,2008,30(3):185~188.
[11] Powers WJ,Rabinstein AA,Ackerson T,et al.2018 guidelines for the early management of patients with acute ischemic stroke:A guideline for healthcare professionals from the American heart association/american stroke association[J].Stroke,2018,49(3):e46~e110.
[12] Jüttler E,Unterberg A,Woitzik J,et al.Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke[J].N Engl J Med,2014,370(12):1091~1100.
[13] Schwake M,Schipmann S,Müther M,et al.Second-look strokectomy of cerebral infarction areas in patients with severe herniation[J].J Neurosurg,2019,132(1):1~9.
[14] 韩毅,邓文涛,刘洋.开颅去骨瓣减压联合颞极或(和)额极切除内减压术治疗大面积脑梗死的效果观察[J].中国医师杂志,2020,22(4):610~612.
[15] 邹敏刚,罗德芳,杨瑞金,等.标准去骨瓣减压联合内减压术对大面积脑梗死患者血流动力学及预后的影响[J].天津医药,2020,48(11):1059~1064,1137.
[16] 袁军辉,石东付,吕岩松,等.标准去大骨瓣减压加内减压术治疗急性大面积脑梗死的临床经验分析[J].中国急救医学,2018,38(2):169~173.
[17] 刘连松.脑挫裂伤失活组织清除程度对预后的影响[J].中华神经外科疾病研究杂志,2014,13(5):455~456.
[18] 李夏良,王伟,辛志成,等.对冲性额颞区脑挫裂伤术中完全清除挫裂脑组织对患者预后的影响[J].创伤外科杂志,2015,17(2):165~165,184.
[19] 中华医学会神经外科学分会,国家卫健委脑卒中筛查与防治工程委员会,海峡两岸医药卫生交流协会神经外科分会缺血性脑血管病学组.大面积脑梗死外科治疗指南[J].中华医学杂志,2021,101(45):3700~3711.
[20] Wang QP,Ma JP,Zhou ZM,et al.Hydrocephalus after decompressive craniectomy for malignant hemispheric cerebral infarction[J].Int J Neurosci,2016,126(8):707~712.

去骨瓣减压联合失活脑组织清除治疗恶性大脑中动脉梗死对患者神经功能恢复及并发症的影响

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Wang Jiaguang, Li Junqing, Zhao Bin, Ma Xiaoer. Effect analysis of superficial temporal artery(STA)-middle cerebral artery(MCA)bypass combined with pedicled temporal parietal fascia application in the treatment of adult moyamoya disease(Analysis of 18 clinical cases) [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(3): 156-160.
[2]	Zhang Xiaoyan, Wang Fenglan, Dang Lei, Gao Yanlei. The diagnostic value of carotid integrative ultrasound and high-resolution MRI 3D black blood technique in cerebral infarction [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(3): 161-164.
[3]	. [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(3): 186-192.
[4]	Lei Hui, Dong Jufeng, Pan Cunyun, Di Li Xiati. Efficacy and safety analysis of 3D slicer 3D reconstruction technology assisted neuroendoscopic surgery in the treatment of cerebral hemorrhage [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 83-88.
[5]	Zhang Chunyan, Hu Yongsheng, Xia Chunhua, He Xinhua, Dong Bin, Chen Bing, Wang Jinwu, Wang Ziyong. The value of 4D-CT Temporal average inversion imaging in the diagnosis of acute ischemic stroke [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 89-94.
[6]	Zhang Mengqi, Xia Chunhua, Zhai Dengyue, Wang Jinwu, Wang Jing, Li Peng. Analysis of predictive efficacy of CT perfusion imaging combined with multi-phase CT angiography in predicting cerebral edema after mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 95-100.
[7]	Yao Meifen, Ding Gangyu, Xu Jianhua, Wang Guojiang. Efficacy ofintravenousthrombolysiswithrt-PAinpeoplewithAcuteMildIschemicStroke [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 101-106.
[8]	. [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 116-119.
[9]	. [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 120-122.
[10]	. [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 123-126.
[11]	Wang Ajun, Zhang Nan, Li Nan, Yang Tao, Li Dongxue, Xia Chengyu. Characteristics and clinical significance of serum lipid metabolism in patients with Moyamoya disease [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(1): 28-32.
[12]	Wu Qiang, Han Zhiqiang, Zhao Jianchun, Pang Yiqiang, Zhang Haitao, Tian Weixia, LAN Xiaoyan, Hao Chenyang. Analysis of the therapeutic effects of intraoperative VR assisted neuroendoscopic hematoma removal and stereotactic intracranial hematoma drainage in the treatment of basal ganglia HICH [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(1): 33-38.
[13]	Yang Lihui, Jia Yanan, Song Jining, Ma Kejie, Su Jianlong, Song Zhijun. Clinical study on the treatment of severe brainstem hemorrhage through subtemporal approach assisted by neuroendoscopy [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(1): 39-43.
[14]	Huangfu Luokai, Mao Jinlong, Rao Wei, Zou Mingming, Cao Weidong, Zhang Jianning. Curative effect of cerebrospinal fluid extraction on puncture and drainage for the treatment of hypertensive intracerebral hemorrhage on the basal ganglia [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(1): 44-47.
[15]	Zhao Qinghai, PanPing, WangShuai, et al. Simple stereotactic puncture and drainage for supratentorial intracerebral hematoma [J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(6): 348-353.