Retrospective Analysis Of 69 Cases Of Large Cerebral Hemispheric Infarction Treated With Internal Medicine

ObjectiveThrough studying the clinical characteristics,imaging findings and test results of the patients with large cerebral hemisphere infarction,and the clinical curative effect comparison between the patients'internal medicine treatment and the partial skull removal and decompression treatment with different surgical opportunity,the aim is to find the best treatment and treatment time.MethodsThe data were analyzed retrospectively,and 69 patients with acute large cerebral hemisphere infarction were collected according to inclusion and exclusion criteria.According to the different treatment conditions and the timing of surgery,A group of 55cases(internal medicine conservative treatment),group B 6 cases(critical herniation of decompressive craniectomy decompression),group C 8 cases(herniation after the treatment of decompressive craniectomy).The infarct volume,median displacement,blood pressure,high sensitivity C-reactive protein,functional recovery and prognosis were compared in three groups.Through the brain CT to record the detection value,screening surgical patients.Results1.Analysis of mortality and prognosis in patients with internal medicine and surgeryMedical group(group A)compared with surgery group(group B and C),the mortality of patients(Fisher exact method,p>0.05)and overall prognosis(t=1.447,p>0.05)had no significant difference,but the infarction area was larger than 200 cm~3(p>0.05).2.The effect of blood pressure change on brain edema in patientsIn B or C group and group A(no hernia patient in the group A)-compared with systolic blood pressure,the increased blood pressure was significantly adverse effect on brain edema,and the difference was statistically significant(p<0.05),diastolic blood pres-sure change was statistically significant increase on brain edema(P<0.05);B compared with group C,systolic blood pressure and diastolic blood pressure had no significant difference in brain edema(p>0.05).3.Clinical study of large cerebral hemispheric infarction patients with midline lateral shift assessment of head CTBrain hernia group(group C),critical group(group B),no brain hernia group(excluding patients with cerebral hernia and critical cerebral hernia in group A),three groups compared,brain herniation on CT and midline lateral shift value have statistical significance(P<0.05).When MLS?5 mm,the possibility of cerebral hernia occurs;when MLS?10 mm,the patient has the possibility of brain hernia,if not to the decompressive hemicraniectom,the patient is likely to die;when MLS<5 mm,the patient may survive.4.Changes of high sensitivity C-reactive protein(hs-CRP)in patients serum and its clinical significanceAccording to the mRS score after 30 days follow-up,the relationship between serum hs-CRP level and prognosis of LHI patients with group A were analyzed retrospectively.The results showed that the difference was statistically significant(p<0.05).mRS score 4-5 or mRS score 6 patients serum hs-CRP level was higher than that of mRS score 0-3patients,statistically significant(p<0.05);There was no significant difference between the serum hs-CRP level in mRS score 4-5 and mRS score 6(p>0.05).Conclusion1.The formation time of brain hernia is generally 48 to 72 hours after onset,and the decompression of decompressive craniectomy can improve the survival rate and prognosis of Large cerebral hemispheric infarction.2.The changes of blood pressure may be related to the expansion of brain edema,and the increase of systolic blood pressure has adverse effects on the expansion of brain edema.3.The midline lateral shift greater than or equal to 5 mm in patients with large cerebral infarction may predict the occurrence of cerebral hernia,the midline lateral shift greater than or equal to 10mm is the high risk factor of cerebral hernia.4.After excluding chronic infection,trauma and autoimmune diseases,the determination of high sensitivity C reactive protein content in venous blood is closely related to the prognosis of large cerebral hemispheric infarction5.Imaging examination of some manifestations can be used as a predictor of malign-nant middle cerebral artery infarction.