標準大骨瓣減壓術治療大面積腦梗死的效果及對ET、BNP的影響

謝嘉濤

【摘要】 目的：探討標準大骨瓣減壓術治療大面積腦梗死的效果及對ET、BNP的影響。方法：選取本院于2017年1月-2018年8月收治的大面積腦梗死患者48例，按照手術方法不同分為對照組（23例）和觀察組（25例），對照組采用傳統去骨瓣減壓術治療，觀察組采用標準大骨瓣減壓術治療。比較兩組患者手術前后GCS評分、梗死面積、血漿腦鈉肽（BNP）和內皮素（ET）水平、臨床療效及不良反應發生情況。結果：觀察組良好/中殘率為68.00%，顯著高于對照組的39.13%（P<0.05）;觀察組死亡率為4.00%，顯著低于對照組的26.09%（P<0.05）;觀察組的重殘/植物生存率與對照組比較，差異無統計學意義（P>0.05）。術后，觀察組GCS評分明顯高于對照組，梗死面積明顯小于對照組（P<0.05）。兩組患者術后ET、BNP水平均低于術前，且觀察組ET、BNP水平均明顯低于對照組（P<0.05）。觀察組患者不良反應發生率為16.00%，顯著低于對照組的47.83%，差異有統計學意義（P<0.05）。結論：標準大骨瓣減壓術治療大面積腦梗死可顯著提高臨床療效，縮小梗死面積，減少死亡率，降低ET、BNP水平，且不良反應少。

【關鍵詞】 標準大骨瓣減壓術; 大面積腦梗死; 腦鈉肽; GCS評分

【Abstract】 Objective：To investigate the effect of standard large bone flap decompression in the treatment of massive cerebral infarction and its influence on ET and BNP.Method：48 patients with massive cerebral infarction admitted to our hospital from January 2017 to August 2018 were selected，according to different surgical methods，the patients were divided into control group（23 cases）and observation group（25 cases）.The control group was treated with traditional decompressive craniectomy，while the observation group was treated with standard decompressive craniectomy.The GCS score，infarct size，plasma BNP，ET levels，clinical efficacy and adverse reactions were compared between the two groups before and after operation.Result：The good/moderate disability rate in the observation group was 68.00%，significantly higher than 39.13% in the control group（P<0.05），the mortality rate in the observation group was 4.00%，significantly lower than 26.09% in the control group（P<0.05），the rate of heavy residue/plant survival in the observation group was not significantly different from that in the control group（P>0.05）.After operation，the GCS score of the observation group was significantly higher than that of the control group，and the infarct area was significantly smaller than that of the control group（P<0.05）.After operation，ET and BNP levels in both groups were lower than those before operation，and the ET and BNP levels in the observation group were significantly lower than those in the control group（P<0.05）.The incidence of adverse reactions in the observation group was 16.00%，significantly lower than 47.83% in the control group，the difference was statistically significant（P<0.05）.Conclusion：Standard large bone flap decompression for the treatment of large cerebral infarction can significantly improve the clinical efficacy，reduce the infarct area，reduce the mortality，reduce the level of ET and BNP，and have fewer adverse reactions.