| Objective:The number of patients who suffered ischemic stroke in China is increasing gradually,and about 10% of these patients have 1arge hemispheric infarction.Even if the patient receives the strictest medical treatment,the death rate can reach 80% with the material cause of severe cerebral hernia.As a surgical treatment for this type of disease,decompressive hemicraniectomy have been accepted by most clinicians.A large number of studies have pointed out that for patients younger than 60 years old,decompressive craniectomy within 48 hours after onset is beneficial to patients.However,due to some controversies in the timing of surgery,the dispute of the operation indication and the decline in the quality of life of major patients after surgery makes the clinical workers hesitate to choose this procedure.In this study,the treatment of patients with1 arge hemispheric infarction treated at the First Hospital of Shanxi Medical University was studied to analyze the effects of early surgical timing and age on the outcomes.Methods:Collected the patients admitted to the first hospital of Shanxi medical university from January 2005 to January 2015 who were diagnosed with 1arge hemispheric infarction.The information of them who have been treated with decompressive hemicraniectomy were enrolled.Inclusion criteria: 1.Preoperative imaging examination indicated that the area of the infarct was greater than two-thirds of the same side of the cerebral hemisphere or the middle cerebral arterial infarction in the brain;2.Who hasbeen operated with decompressive hemicraniectomy;3.No complication of hemorrhage after the infarction;4.No obvious disability before onset.Exclusion criteria: 1.Patients who died of other complications;2.The time between the onset and the operation was greater than 48 hours.By sorting out the patients’ onset to preoperative time,the patients were divided into the ultra-early surgery group(24 hours for the onset)and the early operation group(between 24-48 hours).Registered the survival rate and the evaluating of the modified Rankin scale(mRS)of patients after 1 year of follow-up with survival.SPSS23.0 was used for data statistics by the conducted of the ordered logistic regression test,and the test level was based on the value of α=0.05.Results:There were 71 cases were enrolled,including 18 patients below the age of60(including 60 years old),and 53 patients above the age of 60,aged 40-86 years,with an average age of 62 years old.According to the statistical data,an orderly logistic regression model was established to assign variables: age(X1: greater than 60 years=1,less than or equal to 60 years old=0),and timing of surgery(X2: surgery between 24-48 hours of onset=1,surgery within 24 hours of onset=0).The prognosis for a year after surgery(Y: death=1,m RS score ≥4=2,mRS score<4=3).According to α=0.05 as the test level,the calculation shows that if only consider the age and timing of surgery on patients after impact after one year more.The OR of patients who were treated with ultra-early surgery was 1.481 times higher than that of patients who received early surgery(95%CI:0.517-5.632,χ2=0.768,P=0.381).In patients below 60 years of age,the odds ratio for recovery is 1.706 times that for patients over 60 years of age((95%CI:0.517-4.247,χ2=0.535,P=0.465).Conclusion:The difference in age affects the patients of 1arge hemispheric infarction who have undergone early surgical treatment after the end of the year.Patients aged 60 years orolder can get better.Patients who undergo ultra-early surgery are better off after the first year of treatment than after the early treatment.Therefore,when the age of onset of 1arge hemispheric infarction patient is less than 60 years old,surgery can benefit patients as soon as possible. |
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