去大骨瓣减压术治疗重型颅脑损伤疗效分析
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摘要
目的分析重型颅脑损伤患者采用去大骨瓣减压术治疗的临床疗效。方法该次实验研究对象方便选取2013年1月—2018年9月在该院就诊的100例重型颅脑损伤患者,按照手术方式的差异将所有患者随机分为实验组(50例,采用去大骨瓣减压术治疗)和对照组(50例,采用经典骨瓣开颅术),通过格拉斯哥昏迷评分(GCS)评价患者意识状况,对比两组患者术前、术后6个月颅内压、GCS评分变化、存活率以及预后等情况。结果两组患者术后6个月GCS评分均高于术前(P<0.05),两组患者术后6个月颅内压均低于术前(P<0.05),但实验组患者术后6个月GCS评分、颅内压等指标均优于对照组(P<0.05)。实验组存活43例,对照组存活35例,实验组患者存活率86%显著高于对照组70%(χ2=11.239,P<0.05)。实验组患者恢复良好29例,对照组恢复良好21例,实验组患者恢复良好率58%显著高于对照组42%(P<0.05)。结论重型颅脑损伤患者采用去大骨瓣减压术治疗可取得理想效果,有利于降低颅内压,改善患者预后,是值得推广的一种手术方式。
Objective To analyze the clinical efficacy of decompressive craniectomy for severe craniocerebral injury. Methods 100 patients with severe craniocerebral injury from January 2013 to September 2018 were convenient randomly divided into experimental group(50 cases treated with decompression of large bone flap) and control group(50 cases treated with classical craniotomy). Consciousness was assessed by Glasgow Coma Score(GCS). Intracranial pressure, GCS score, survival rate and prognosis were compared between the two groups before and 6 months after surgery. Results The GCS scores of the two groups at 6 months after operation were higher than those before operation(P<0.05). The intracranial pressure of the two groups at 6 months after operation was lower than that before operation(P<0.05), but the GCS scores and intracranial pressure of the experimental group at 6 months after operation were better than those of the control group(P<0.05). The survival rate of the experimental group was 86% significantly higher than that of the control group 70%(χ2=11.239, P<0.05). 29 cases in the experimental group recovered well and 21 cases in the control group recovered well. The recovery rate in the experimental group was 58% higher than that in the control group 42%(P<0.05). Conclusion Decompression with large craniotomy can achieve ideal results in patients with severe craniocerebral injury, is conducive to reducing intracranial pressure,improve the prognosis of patients, is worth promoting a surgical approach.
Objective To analyze the clinical efficacy of decompressive craniectomy for severe craniocerebral injury. Methods 100 patients with severe craniocerebral injury from January 2013 to September 2018 were convenient randomly divided into experimental group(50 cases treated with decompression of large bone flap) and control group(50 cases treated with classical craniotomy). Consciousness was assessed by Glasgow Coma Score(GCS). Intracranial pressure, GCS score, survival rate and prognosis were compared between the two groups before and 6 months after surgery. Results The GCS scores of the two groups at 6 months after operation were higher than those before operation(P<0.05). The intracranial pressure of the two groups at 6 months after operation was lower than that before operation(P<0.05), but the GCS scores and intracranial pressure of the experimental group at 6 months after operation were better than those of the control group(P<0.05). The survival rate of the experimental group was 86% significantly higher than that of the control group 70%(χ2=11.239, P<0.05). 29 cases in the experimental group recovered well and 21 cases in the control group recovered well. The recovery rate in the experimental group was 58% higher than that in the control group 42%(P<0.05). Conclusion Decompression with large craniotomy can achieve ideal results in patients with severe craniocerebral injury, is conducive to reducing intracranial pressure,improve the prognosis of patients, is worth promoting a surgical approach.
引文
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[4]张康,高翔,李文平,等.大骨瓣减压与常规骨瓣减压治疗重型颅脑损伤的对照研究[J].东南国防医药,2015,27(3):256-258.
[5] Shi Xiangfei. Clinical analysis of standard large bone flap decompression for severe craniocerebral injury[J]. Practical Journal of Cardiovascular and Pulmonary Diseases, 2015, 28(9):87-90.
[6]张旭,梁君,桑奔.大骨瓣减压术治疗大面积脑梗死的疗效评价[J].中国卒中杂志,2016,5(10):842-846.
[7]权瑜,巩守平,吕健,等.控制性减压术对中老年重型颅脑损伤的治疗效果评价[J].解放军医药杂志,2016,27(2):66-69.
[8]张晓亮,朱端权,蒋向东.改良切口去大骨瓣减压术在重型颅脑损伤救治中的应用[J].创伤外科杂志,2015,7(4):357.
[9]罗小鹏,陈二南,陈贵业.重型颅脑损伤去骨瓣减压术预后分析[J].创伤外科杂志,2015,27(2):105-108.
[10]李锐,郎志刚,欧阳荣健.重型颅脑损伤改良大骨瓣减压术的疗效[J].创伤外科杂志,2016,18(8):500-502.
[11]胡均贤.预见性双侧平衡去骨瓣减压术治疗重型闭合性颅脑损伤75例[J].安徽医药,2016,20(7):1366-1368.
[12]王龙珍,贡平.70例重型颅脑损伤的手术疗效分析[J].西南国防医药,2017,27(5):501-503.
[2]余建荣.标准大骨瓣手术治疗重型颅脑外伤临床分析[J].当代医学,2015,21(29):32-33.
[3]侯勇,刘仍利,泮双军,等.改良开颅去骨瓣减压术治疗重型颅脑外伤112例临床观察[J].浙江中西医结合杂志,2014,12(10):900-902.
[4]张康,高翔,李文平,等.大骨瓣减压与常规骨瓣减压治疗重型颅脑损伤的对照研究[J].东南国防医药,2015,27(3):256-258.
[5] Shi Xiangfei. Clinical analysis of standard large bone flap decompression for severe craniocerebral injury[J]. Practical Journal of Cardiovascular and Pulmonary Diseases, 2015, 28(9):87-90.
[6]张旭,梁君,桑奔.大骨瓣减压术治疗大面积脑梗死的疗效评价[J].中国卒中杂志,2016,5(10):842-846.
[7]权瑜,巩守平,吕健,等.控制性减压术对中老年重型颅脑损伤的治疗效果评价[J].解放军医药杂志,2016,27(2):66-69.
[8]张晓亮,朱端权,蒋向东.改良切口去大骨瓣减压术在重型颅脑损伤救治中的应用[J].创伤外科杂志,2015,7(4):357.
[9]罗小鹏,陈二南,陈贵业.重型颅脑损伤去骨瓣减压术预后分析[J].创伤外科杂志,2015,27(2):105-108.
[10]李锐,郎志刚,欧阳荣健.重型颅脑损伤改良大骨瓣减压术的疗效[J].创伤外科杂志,2016,18(8):500-502.
[11]胡均贤.预见性双侧平衡去骨瓣减压术治疗重型闭合性颅脑损伤75例[J].安徽医药,2016,20(7):1366-1368.
[12]王龙珍,贡平.70例重型颅脑损伤的手术疗效分析[J].西南国防医药,2017,27(5):501-503.