AORN J. 2021 Jul;114(1):34-46. doi: 10.1002/aorn.13430.
Decompressive hemicraniectomy (DHC) is a procedure performed in the setting of malignant cerebral edema after a large middle cerebral artery stroke. The decision to proceed with surgical decompression is one that must be made judiciously and rapidly. Although this can be a life-saving surgery, it does not necessarily improve the patient's quality of life. The neurosurgical team must thoroughly discuss the patient's comorbidities, age, dominant versus nondominant hemispheric injury, and neurological expectations, and the procedure itself (ie, risks, benefits, expected postoperative course, goals of care) with the patient and his or her family before DHC. This article briefly reviews the anatomy of the brain and stroke presentation and provides an overview of DHC and the perioperative course. The article concludes with a case study of a patient with a medical history of hypertension and prediabetes who presents to the emergency department after a fall and undergoes an emergent DHC.
去骨瓣减压术（DHC）是一种在大脑中动脉大卒中后发生恶性脑水肿时进行的手术。是否进行手术减压的决策必须明智而迅速地做出。虽然这可能是一种挽救生命的手术，但它并不一定能提高患者的生活质量。神经外科团队必须在 DHC 之前与患者及其家属彻底讨论患者的合并症、年龄、优势半球与非优势半球损伤以及神经预期，并讨论手术本身（即风险、益处、预期术后过程、护理目标）。本文简要回顾了大脑解剖结构和中风表现，并概述了 DHC 及其围手术期过程。文章最后通过一个高血压和糖尿病前期病史的患者病例研究，该患者在跌倒后到急诊就诊并接受了紧急 DHC。
