| Objectives: The clinical application of large bone flap decompression can increase the volume of the cranial cavity,thus has decompression effect,and can increase cerebral perfusion,prevent cerebral hernia caused by the increase of infarction and edema range,can significantly reduce the mortality of patients with large cerebral infarction.However,large bone flap decompression is often used as an alternative "lifesaving" procedure after conservative treatment is ineffective.Because of the controversy of this procedure,it is only performed in individual hospitals.In addition,the related studies of this operation are mostly aimed at evaluating the relevant indicators of 6 months after surgery.The follow-up time is shorter,and the long-term prognosis of survivors is shorter.Less post evaluation.Therefore,this study will be selected into surgical treatment group and medical treatment group,through the comparison of two groups of patients with therapeutic effect,neurological function,HIF-1 and PLA levels and prognosis,to select the best treatment of large-area cerebral infarction,surgical timing and surgical methods were studied in order to reduce the mortality of large-area cerebral infarction.Methods: According to the selected criteria,60 patients with massive cerebral infarction were selected for surgical treatment.According to the imaging findings of each patient,the surgical methods were divided into super-early + large bone flap decompression alone(12 cases),super-early + large bone flap decompression and partial ischemic tissue resection(6 cases),selective + large bone flap decompression alone(30 cases).Elective + removal of large bone flap and resection of partial ischemic tissue(12 cases).Another 58 cases of massive cerebral infarction were treated by conservative treatment,and standardized treatment was adopted.The therapeutic effect,neurological function,HIF-1,PLA level and prognosis of the 2 groups were evaluated.Results:1.There Among 60 patients with massive cerebral infarction,12 died,the mortality rate was 20.00%;6 died of pulmonary infection,2 died of multiple organ failure,and 4 gave up treatment,including 8 died aged over 60;58 of conservative treatment,32 died(the mortality rate was 55.17%)with statistical significance(P<0.05).There were 18 cases of Super-early operation,0 cases of death(0%),42 cases of selective operation,12 cases of death(28.57%),12 cases of Super-early + simple large bone flap decompression,0 cases of death(0%),6 cases of Super-early + large bone flap removal and partial ischemic brain tissue removal,0 cases of death(0%),30 cases of selective + simple large bone flap removal,8 cases of death(26.67%).Removal of large bone flap and partial ischemic brain tissue in 10 cases,4 cases died(40.00%).Compared with elective surgery,the mortality of ultra-early surgery was lower,the difference was statistically significant(P<0.05).2.After treatment,the total effective rate of the surgical treatment group was higher than that of the conservative treatment group(P<0.05).3.Compared with before treatment,the volume,midline displacement and NIHSS scores of cerebral infarction on CT images of the two groups were lower and the GCS scores were higher after treatment(P<0.05).Compared with the conservative treatment group,the volume,midline displacement and NIHSS scores of cerebral infarction on CT images of the surgical treatment group were lower,and the GCS scores were higher(P<0.05).4.Compared with the conservative treatment group,the good rate of language function in the surgical treatment group was higher(P < 0.05).5.After treatment,compared with the conservative treatment group,the surgical treatment group had longer hospitalization time,ICU time and higher hospitalization costs(P < 0.05).The surgical treatment group had 4 cases of gastrointestinal bleeding,10 cases of pulmonary infection,6 case of multiple organ failure,the total incidence of complications was 20.00%(12/60),and the conservative treatment group had digestive tract discharge.The total incidence of complications was 34.48%(20/60).There was no significant difference between the two groups in the incidence of complications(P > 0.05).6.Compared with before treatment,the levels of HIF-1α in peripheral blood of the two groups increased after 3 days of treatment,the difference was statistically significant(P < 0.05).The difference was statistically significant(P < 0.05).The level of HIF-1α in the treatment group was lower than that in the control group 3 days after treatment and 10 days after treatment,the difference was statistically significant(P < 0.05).7.Compared with before treatment,the expression of PLA,PMA,PNA and PlyA in the two groups decreased after treatment(P <0.05),and the expression of PLA,PMA,PNA and PlyA in the surgical treatment group was lower than that in the conservative treatment group(P <0.05).8.Most of the 24 patients in the surgical treatment group survived until 1 year after follow-up,and no one was in a persistent vegetative state.Among them,6(12.50%)were completely dependent on others(mRS 5),10(20.00%)were unable to walk independently,and 16(mRS 2-3)were well recovered.Four(16.67%)of the 26 patients in the conservative treatment group were able to walk independently,and only 8(16.67%)needed some help from others(mRS 3)in their daily life,accounting for 17%.8(16.67%)did not need help from themselves to take care of their daily affairs(mRS 2).4 of the 26 patients in the conservative treatment group died after a follow-up period of one year,and 6 were completely dependent on others(mRS 5).6 cases(27.27%),6 cases(27.27%)were unable to walk independently,and 6 cases(27.27%)were able to walk independently.2 case(9.09%)was able to walk independently,and 2 case(9.09%)was able to take care of daily affairs without help(mRS 2)in 2 cases(9.09%).After 6 months and 1 year of treatment,the BI score of surgical treatment group was higher and the mRS score was lower than that of the conservative treatment group(P < 0.05).Conclusions: Large bone flap decompression treatment of cerebral infarction has a better effect,the mortality rate is lower than the conservative medical treatment group,nerve function repair,language function repair and consciousness state are better than the conservative medical treatment group,the incidence of complications is lower,but the cost of hospitalization is higher than the conservative medical treatment group,hospitalization time is longer.Combined with CT and other imaging techniques,ultra-early decompression of large bone flap can significantly reduce the mortality of massive cerebral infarction.Large bone flap decompression can lower the level of HIF-1a in patients with acute cerebral infarction,and the level of HIF-1 in serum can provide reference for evaluating the curative effect.Large bone flap decompression can decrease the expression of PLA,PMA,PNA and PlyA in patients with acute cerebral infarction,which plays an important role in improving the state of cerebral ischemia and reperfusion injury.Follow-up for 6 months and 1 year showed that the quality of life of large bone flap decompression was better than that of the conservative treatment group,and the long-term prognosis was goodpatients. |
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