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題名 | 開顱減壓術應用於大範圍腦梗塞病人之療效=Outcome of Decompressive Surgery for Massive Hemispheric Infarction |
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作者 | 馮淑芬; 邱浩彰; 陳俊榮; 蔡明達; Feng, Shu-fen; Chiu, Hou-chang; Chen, Jiunn-rong; Tsai, Ming-dar; |
期刊 | 臺灣醫學 |
出版日期 | 19980700 |
卷期 | 2:4 1998.07[民87.07] |
頁次 | 頁403-412 |
分類號 | 416.291 |
語文 | chi |
關鍵詞 | 開顱減壓術; 腦梗塞; 加拿大神經學量表; 巴氏指數; Decompressive craniectomy; Cerebral infarct; Canadian neurological scale; Barthel index; |
中文摘要 | 針對開顱減壓術應用於大範圍腦梗塞病患之療效評估,依加拿大神經學量表 (Canadian Neurological Scale)及巴氏指數(Barthel Index),分析比較開顱組九例病患及 對照組十一人術前術後/內科治療前後之神經學功能變化。所有開顱組病人術後都存活下來 並恢復意識,神經功能也有統計學上有意義的進步。對照組則有四例死於腦疝脫,三例一直 未清醒。整體而言,對照組在治療前後,神經學功能無顯著變化。因此,對預防腦水腫所致 之腦疝脫,開顱減壓術可能可減少死亡率,並增加防止植物人之機會。只是,病人的選擇上 可能得更謹慎,以期達到更令人滿意的結果。 |
英文摘要 | Massive supratentorial infarctions are often associated with severe brain swelling and death secondary to herniation. Contemporary treatment modalities involving hyperventilation, osmodiuretic agents, and steroids are frequently ineffective in reducing the acute cerebral edema that follows infarction. Decompressive craniectomy provides a new method for prevention of uncal herniation. However, the of patients receiving this operation, clinical outcome, the criteria for patient selection, and the optional timing of surgery are still controversial. We report a retrospective series of nine patients presented with who progressive neurologic deterioration during medical therapy for large hemispheric infarct. Four patients of these patients had dominant hemisphere infarction. Author eleven patients were treated conservatively as a control group. Pre- and post-ictal Canadian Neurological Scale scores were recorded and the functional recovery was evaluated the Barthel index. Seven of the nine surgically treated patients demonstrated neurologic improvement on the seventh postoperative day. All of them survived and regained consciousness later. After rehabilitation training, three patients were functionally independent while two were severely disabled. Patients with dominant hemisphere infarct recovered as well as those with stroke in non-dominant hemisphere, though motor aphasia was inevitable left. In the control group, four patients died of uncal herniation, three were bed-ridden with cloudy consciousness, and the others achieved neurological improvement. For patients with massive supratentorial infarction, decompressive surgery is effective in life-saving but caution should be exercised in selecting candidates to achieve a favorable outcome. |
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