Kết quả điều trị mở sọ sớm ở bệnh nhân nhồi máu não diện rộng=Early decompressive hemicraniectomy in supratentorial malignant ischemic stroke

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Tác giả: Hoàng Ngọc Nguyễn, Thúy Linh Nguyễn, Trọng Yên Nguyễn, Văn Tuyến Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.156-162

Bộ sưu tập: Metadata

ID: 242211

Thêm vào giỏ

Đánh giá kết quả điều trị các bệnh nhân (BN) nhồi máu não diện rộng (NMNDR) bằng phương pháp mở sọ giảm áp sớm ≤ 48 giờ và phân tích một số yếu tố liên quan đến kết quả điều trị. Đối tượng: 29 BN NMNDR điều trị tại khoa đột quỵ Bệnh viện TWQĐ 108 từ tháng 01/2022 - 01/2024, 7 BN phẫu thuật sau 48 giờ bị loại ra khởi nghiên cứu, 23 BN phẫu thuật trong ≤ 48 giờ được tuyển chọn vào nghiên cứu. Phương pháp nghiên cứu: Mô tả cắt ngang. Kết quả: 23 (30,4%) BN NMNDR mở sọ sớm có tỷ lệ hồi phục chức năng thần kinh tốt (mRS≤3) sau 6 tháng ra viện
tỷ lệ tử vong (34,8%). Trong các bệnh lý nền, rung nhĩ và tăng huyết áp chiểm tỷ lệ cao. Khi phân tích hồi quy đa biến, chỉ có biến tuổi là yếu tố tiên lượng độc lập đến kết cục hồi phục chức năng thần kinh (mRS) xấu hơn, tuổi càng cao mRS càng cao, khả năng hồi phục chức năng thần kinh càng thấp (p<
0,05). Không có sự khác biệt về mức độ hồi phục chức năng thần kinh giữa nam và nữ
giữa tổn thương thuộc bán cầu trái hay phải và tình trạng điều trị trước đó như tiêu sợi huyết hay can thiệp mạch, điểm NIHSS và điểm Glassgow trước mổ. Kết luận: Các BN NMNDR có tỷ lệ tử vong và khuyết tật cao mặc dù được điều trị tích cực, phẫu thuật sớm trong 48 giờ là cứu cánh cải thiện tiên lượng cho bệnh nhân.Evaluate the results of patients with malignant ischemic stroke infarction underwwent early decompressive craniotomy within ≤ 48 hours and analyze some factors related to the outcome of these patients. Method: cross-sectional study 29 patients with large-scale cerebral infarction treated at the stroke department of Central Hospital 108 from January 2022 - January 2024, 7 patients who had surgery after 48 hours were excluded from the study, 23 Patients who had surgery within 48 hours were recruited into the study. Results: 23 patients underwent early decompression hemicraniectomy, the rate of good outcome (mRS≤3) after 6 months reached 30,4%
The mortality rate is 34,8%. Among the underlying diseases, atrial fibrillation and hypertension are the most common. When analyzing multivariable regression, only age is an independent prognostic factor, so the worse the neurological recovery result (mRS), the older the age, the higher the mRS, the greater the likelihood of poor neurological recovery with p<
0.05. There is no significant difference between men and women
between left and right hemisphere damage and previous treatment such as blood pressure, NIHSS score and Glasgow score before surgery. Conclusion: Although the high rate of mortality and morbility in malignant ischemic stroke, early surgery within 48 hours can help improve the patient's prognosis.

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