目的探讨大骨瓣减压术治疗大面积脑梗死的临床效果和内科保守治疗临床效果。 方法回顾性研究总结徐州医科大学附属医院2012年1月-2015年1月41例大面积脑梗死后行去骨瓣减压手术治疗的患者和30例大面积脑梗死后行内科保守治疗的患者，比较两组患者的死亡率及对生存者中两组患者不同时期的神经功能变化进行随访（12个月），评价术后3个月和12个月时的预后评分（Glasgow Outcome Scale，GOS）变化。 结果手术治疗组与内科保守对照组相比较，死亡率明显降低（χ2=4.522，P=0.02）。手术治疗组中60岁以上患者死亡率明显比60岁以下患者要高（χ2=5.634，P=0.04）。根据GOS进行临床评分，手术治疗组术后3个月和12个月随访结果，较内科保守对照组发病3个月和12个月随访结果，患者死亡率降低，且患者生活质量提高明显（χ2=6.437，P=0.03）。 结论大面积脑梗死手术治疗组比保守治疗组可明显降低患者死亡率，且患者生活质量提高明显。%Objective To investigate the clinical effect of medical treatment and decompressive craniectomy in treatment of massive cerebral infarction. Methods Decompressive craniectomy was performed in 41 patients with massive cerebral infarction from January 2012 to January 2015 in Xuzhou Medical University Afifliated Hospital. The data of these 41 patients and 30 patients who received conservative medical treatment after massive cerebral infarction were retrospectively studied. The changes of Glasgow Outcome Scale (GOS) of functional recovery at 3 and 12 months after surgery and mortality rates between two groups were compared retrospectively. Results Comparing the operative patients and medical treatment patients, the mortality of operative patients was lower, and overall prognosis of operative patients was better (χ2=4.522,P=0.02). The mortality of operative patients above the age of 60 was higher than those under 60 (χ2=5.634, P=0.04). The comparison between operative patients and medical treatment patients were categorized according to the GOS classiifcation 3 months later and 12 months later after discharge. The comparison between operative patients and medical treatment patients in 3 months later and 12 months later: overall prognosis was better and the disability rate of survivors was lower (χ2=6.437, P=0.03). Conclusion Comparing the surgical therapy with medical treatment in the massive hemispheric infarction patients, the surgical therapy decreases mortality and improves the quality of life.
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