本文選題：大面積腦梗死 + 腦水腫��； 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：大面積腦梗死(massive cerebral infarction, MCI)通常是指頸內(nèi)動脈主干、大腦中動脈(middle cerebral artery, MCA)主干的腦卒中,發(fā)生率約占所有缺血性腦卒中的10%。從細(xì)胞毒性腦水腫到血管源性腦水腫再到晚期占位性腦水腫的急劇出現(xiàn)是MCI的主要病理特點。由于顱腔的封閉性,腦組織體積增加,必然導(dǎo)致顱內(nèi)壓(intracranial pressure, ICP)逐漸增高,ICP增高又會導(dǎo)致腦灌注壓(cerebral perfusion pressure, CPP)、腦血流量(cerebral blood flow, CBF)的降低,進(jìn)一步加重腦水腫,形成了ICP增高的惡性循環(huán),最后因腦疝形成而導(dǎo)致患者死亡。目前,許多降低ICP的內(nèi)科治療措施,均未獲得肯定療效。而且,即使采取最佳的內(nèi)科治療方法也無法完全打破此惡性循環(huán),其死亡率仍高達(dá)80%,而存活患者多遺留嚴(yán)重的神經(jīng)功能障礙。相較于內(nèi)科治療而言,去骨瓣減壓術(shù)(decompressive hemicraniectomy, DHC)則是一種有效的外科治療手段,它能降低患者死亡率及改善其功能預(yù)后。三大隨機對照臨床試驗(DECIMAL, DESTINY, HAMLET)研究結(jié)果及相關(guān)的匯總分析證實,早期行外科減壓術(shù)不僅能降低患者死亡率而且能改善神經(jīng)功能障礙。目前,很多的MCI患者因DHC而獲益,但不可否認(rèn)的是,DHC術(shù)后患者遺留的不同程度的神經(jīng)功能障礙也引發(fā)了相應(yīng)的倫理問題。因此,是否每個MCI患者均需行DHC治療,首先應(yīng)對MCI患者進(jìn)行認(rèn)真篩選,同時需嚴(yán)格把握手術(shù)時機和采取適宜的手術(shù)方式,方能取得滿意的治療效果。這篇綜述目的主要在于對MCI的外科治療問題及策略進(jìn)行一個概述。
[Abstract]:Large area cerebral infarction with massive cerebral infarction, MCI) usually refers to the main trunk of internal carotid artery, middle cerebral artery, MCA) trunk of middle cerebral artery, the incidence of which is about 10% of all ischemic stroke. The main pathological features of MCI are from cytotoxic brain edema to vasogenic brain edema to late occupying brain edema. As a result of the closure of the skull cavity and the increase of the volume of brain tissue, it is inevitable that the intracranial pressure will increase gradually and the ICP will increase, and the cerebral perfusion pressure will be increased, and the cerebral perfusion pressure, the cerebral blood flow and the cerebral blood flow, CBF) will be decreased, which will further aggravate the cerebral edema. This leads to a vicious circle of increased ICP and eventually death from brain hernia. At present, many medical treatment measures to reduce ICP have not obtained positive effect. Moreover, even if the best medical treatment can not completely break this vicious circle, the mortality rate is still as high as 80%, while the surviving patients have many serious neurological dysfunction. Compared with medical treatment, decompression of bone flap decompression (DHCs) is an effective surgical treatment, which can reduce mortality and improve functional prognosis. The results of three randomized controlled clinical trials DECIMALL DESTINY and HAMLET showed that early surgical decompression could not only reduce the mortality of patients but also improve neurological dysfunction. At present, many MCI patients benefit from DHC, but it is undeniable that the different degrees of neurological dysfunction caused by DHC patients also lead to the corresponding ethical problems. Therefore, if every MCI patient should be treated with DHC, the first step should be to carefully screen the MCI patients, and at the same time, we should strictly grasp the operation opportunity and adopt the appropriate operation method to obtain satisfactory therapeutic effect. The purpose of this review is to summarize the surgical treatment problems and strategies of MCI.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.12

【相似文獻(xiàn)】

相關(guān)期刊論文 前5條

1 唐曉磊;孫桂軍;;大面積腦梗死25例臨床分析[J];中國社區(qū)醫(yī)師(醫(yī)學(xué)專業(yè));2011年26期

2 高倩;;大面積腦梗死的臨床特點及護(hù)理[J];當(dāng)代醫(yī)學(xué);2010年04期

3 高玉蘋;;150例大面積腦梗死預(yù)后相關(guān)因素分析[J];北京醫(yī)學(xué);2009年08期

4 柴寧;;大面積腦梗死患者96例護(hù)理體會[J];陜西醫(yī)學(xué)雜志;2011年04期

5 ;[J];;年期

相關(guān)碩士學(xué)位論文 前1條

1 馬明;大面積腦梗死外科治療的問題與策略[D];重慶醫(yī)科大學(xué);2015年

，

本文編號：1844863