中老年大面积脑梗死的非手术治疗效果

唐劭年  胡宗继  巴特尔  李哲  刘立雄

[摘要] 目的 为了进一步探讨中老年大面积脑梗死疾病的非手术治疗效果，探讨脑梗死伤残率与脑梗死后抑郁症之间的关系。 方法 根据我院2007年8月～2013年8月间收治的中老年大面积脑梗死疾病患者的临床资料，选取75例伴脑梗死后抑郁症患者，采用抗脑梗死药物以及抗抑郁药物进行治疗，观察患者治疗情况以及脑梗死与脑梗死后抑郁症的相对关系。 结果 中年患者35例，死亡率为31.43%，残障率为22.86%，患者远期预后较老年组好；老年患者40例，死亡率为37.5%，残障率为30%，患者早期以及伴合并症者死亡率较高，预后差。脑梗死后抑郁症治疗情况：重度患者疗效差，内源性患者疗效差，中轻度患者疗效较佳。脑梗死与脑梗死后抑郁相互作用。 结论 中老年大面积脑梗死患者采用保守药物治疗效果较为稳定，但存在一定的局限性，与手术治疗相比治疗过程更安全，对患者机体环境要求较低，可做特殊患者以及不适做手术的脑梗死患者一般治疗方式，控制患者抑郁症情况也可降低死亡以及残障率。

[关键词] 中年疾病；大面积脑梗死；非手术治疗

[中图分类号] R743.3   [文献标识码] B   [文章编号] 2095-0616（2014）09-205-03

Non-surgical curative effect of massive cerebral infarction for middle-aged and elderly patients

TANG Shaonian  HU Zongji  BA Te'er  LI Zhe  LIU Lixiong

Department of Neurology,Sun Yat-Sen University Affiliated Dongguan Hospital,Dongguan 523110,China

[Abstract] Objective To further explore the non-surgical curative effect of massive cerebral infarction for middle-aged and elderly patients, and to analyze the relations between the disability rate of cerebral infarction and cerebral infarction-induced depression. Methods According to the clinical data obtained from middle-aged and elderly patients with massive cerebral infarction who were admitted to our hospital from August 2007 to August 2013,75 patients with cerebral infarction-induced depression were selected and given anti-cerebral infarction drugs and anti-depression drugs for the treatment.The curative effect and the relations between cerebral infarction and depression were observed. Results There were 35 middle-aged patients.Their mortality rate was 31.43%,disability rate was 22.86% and long-term prognosis was better than that of the elderly patients;there were 40 elderly patients. Their mortality rate was 37.5% and the disability rate was 30%. The mortality rate was higher for early stage and complications,and the prognosis was poor. Conclusion Of treating cerebral infarction-induced depression:the curative effect was poor for severe patients and endogenous patients, and better for mild and moderate patients. The cerebral infarction was interacting with cerebral infarction-induced depression. Conclusion The curative effect of conservative medicine is stable for treating massive cerebral infarction for middle-aged and elderly patients,but has certain limitations.Its treatment process is safer than that of a surgical treatment, and it has a lower requirement for patients'health condition.The method can be used as a general treatment for special patients or patients not suitable for surgery.Controlling patients'depression also helps lower mortality and disability rate.

[Key words] Middle-aged disease;Massive cerebral infarction;Non-surgical treatment

脑梗死是常见的脑血管疾病，尤其是发生在脑中动脉及颈动脉系统的梗死威胁尤为严重。中老年患者脑血管系统出现大面积梗死会导致患者失语、偏瘫、意识不清、瞳孔异状等问题[1]，且治疗效果不佳，患者预后差[2]，是一种较为严重的脑部疾病。当前临床治疗方式主要以保守的抗脑梗死药物治疗以及减压手术治疗为主，由于脑中动脉愈合差，中老年患者体质易出现术中应激反应，所以减压手术的临床治疗效果存在争议[3]。……