关键词: 脑梗死；灌注成像；减压术, 外科；大面积脑梗死；CT灌注成像；标准去骨瓣减压；内减压；预后

Abstract: Objective　To investigate the hemodynamic changes after standard decompressive craniectomy combined with internal decompression in the treatment of large hemispheric infarction and analyze its prognosis. Methods　Forty-two patients with large hemispheric infarction who underwent surgical treatment in our hospital from January 2017 to February 2020 were collected and divided into 2 groups according to different surgical methods. The patients in the study group (n=22) were performed standard decompressive craniectomy and internal decompression, and the patients in the control group (n=20) were performed standard decompressive craniectomy. The NIHSS score before and 14 days after operation, Barthel Index and fatality rate at 90d were analyzed in the two groups. Meanwhile, all patients completed CT perfusion (CTP) imaging before and 14 days after operation. The absolute values of cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT) in the infarction core area, the contralateral mirror area, and the peri-infarct zone (PIZ) were measured and compared between the two groups. Results　The NIHSS scores were significantly decreased after operation compared with those before operation in the two groups (P＜0.01), and the Barthel indexes were significantly increased after surgery (P＜0.01). After surgery, the NIHSS score was significantly decreased in the study group compared with that of the control group, and the Barthel index was significantly increased in the study group compared with that of the control group (P＜0.05). There was no significant difference in the mortality between the two groups (P＞0.05). The CBF and CBV of the infarction core area were significantly increased after operation in the study group, and both were higher than those in the control group (P＜0.01). In the PIZ area, the CBF was increased after operation, and MTT was decreased after operation in the control group (P＜0.05). There were no significant differences in the CBV and TTP before and after operation in the control group (P＞0.05). The CBF and CBV in the PIZ area were significantly increased after surgery in the study group, and both were significantly higher than those of the control group (P＜0.05). In the same region and group, the TTP and MTT, which were significantly shorter than those before the operation, were also significantly lower than those in the control group (P＜0.01). After the operation, the CBF and CBV of the contralateral mirror area were significantly increased in the two groups, and the TTP and MTT were significantly shortened (P＜0.05). There were no statistically significant differences in terms of postoperative parameters between the two groups (P＞0.05). Conclusion　Standard decompressive craniectomy combined with internal decompression can improve the hemodynamics of patients with large hemispheric infarction, especially enhance the blood perfusion in the PIZ, and obviously promote the recovery of neurological function.

Key words: brain infarction, perfusion imaging ;decompression, surgical;large hemispheric infarction, CT perfusion imaging, standard decompressive craniectomy, internal decompression, prognosis