Benejam Bessy, Sahuquillo Juan, Poca Maria Antonia, Frascheri Laura, Solana Elisabeth, Delgado Pilar, Junqué Carme
Neurosurgery and Neurotraumatology Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Neurol. 2009 Jul;256(7):1126-33. doi: 10.1007/s00415-009-5083-9. Epub 2009 Mar 14.
Malignant middle cerebral artery (MMCA) infarction is associated with a mortality rate of 80% under conservative treatment. Decompressive hemicraniectomy (DH) reduces mortality and improves the functional outcome of surviving patients. The purpose of this study was to examine quality of life (QoL) and neurobehavioral deficits in patients with space-occupying infarctions of the right- or left-sided hemisphere at 6 months after stroke. The Sickness Impact Profile (SIP) was used to assess QoL in 19 out of 29 consecutive patients that underwent DH after a malignant MCA infarction (14 on the right and 5 on the left hemisphere). Behavioral changes were evaluated with the Frontal Behavioral Inventory and the Beck Depression Inventory. Patients and relatives were also asked if, knowing the present outcome, they would agree again, in retrospect, to a DH. Barthel Index >60 was seen in 37% of our patients. Functional outcome was related to age. We found a higher reduction in the SIP's physical domain than in the psychosocial domain. Depressive symptoms were present in 50% of the patients. We didn't find significant differences in QoL or functional outcome between patients with right or left-sided infarctions. The most frequent neurobehavioral symptoms were decreased speech output, apathy, reduced spontaneity and irritability. Most patients and their relatives would again give consent to hemicraniectomy. The results show that younger patients had a significantly better outcome. QoL seems to be acceptable in both left- and right-sided infarctions, and retrospective agreement to hemicraniectomy is high in both patients and their relatives.
大脑中动脉恶性梗死（MMCA）在保守治疗下死亡率为80%。去骨瓣减压术（DH）可降低死亡率并改善存活患者的功能结局。本研究旨在探讨脑卒后6个月时，右侧或左侧半球占位性梗死患者的生活质量（QoL）和神经行为缺陷。采用疾病影响量表（SIP）对29例连续接受大脑中动脉恶性梗死后去骨瓣减压术患者中的19例进行生活质量评估（右侧14例，左侧5例）。用额叶行为量表和贝克抑郁量表评估行为变化。还询问了患者及其亲属，如果知道目前的结果，他们事后是否会再次同意接受去骨瓣减压术。我们37%的患者巴氏指数>60。功能结局与年龄有关。我们发现SIP身体领域的下降幅度高于心理社会领域。50%的患者存在抑郁症状。我们未发现右侧或左侧梗死患者在生活质量或功能结局方面存在显著差异。最常见的神经行为症状是言语输出减少、冷漠、自发性降低和易怒。大多数患者及其亲属会再次同意进行去骨瓣减压术。结果显示，年轻患者的结局明显更好。左右侧梗死患者的生活质量似乎都可以接受，患者及其亲属对去骨瓣减压术的回顾性同意率都很高。
