分步控制性减压术治疗重型脑外伤的临床应用
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摘要
目的观察分步控制性减压术治疗重型脑外伤的临床效果,并评价其临床应用价值。方法回顾性分析2015年5月至2017年5月唐山市第三医院收治的93例重型颅脑损伤患者的临床资料,其中45例行常规开颅血肿清除及去骨瓣减压术者视为对照组,48例行分步控制性减压术者视为观察组;观察两组患者术中、术后即刻、术后6个月的颅内压改变情况,以及术后6个月的格拉斯哥昏迷评分(GCS)、神经行为认知状态检查表评分(NCSE)、日常生活活动能力评分(Barthel指数),统计两组患者的格拉斯哥结局评分(GOS)以及术中和术后并发症发生情况。结果观察组术中、术后即刻、术后6个月的颅内压均低于对照组(P<0.05);观察组术后6个月的GCS、NCSE、Barthel指数均高于对照组(P<0.05);观察组的预后良好率(GOS评分4~5分)高于对照组(P<0.05);术后脑梗死发生率组间比较差异无统计学意义(P>0.05),但观察组的其他并发症发生率均低于对照组(P<0.05),观察组的术中和术后并发症总发生率低于对照组(P<0.05)。结论对重型脑外伤患者实施分步控制性减压术可有效稳定患者颅内压,减少术中和术后并发症发生率,这对提高手术安全性和疗效有重要价值。
Objective To observe the clinical effect of stepwise controlled decompression in treatment of patients with severe cerebral trauma and evaluate its clinical significance. Methods The clinical data of 93 patients with severe craniocerebral injury admitted in this hospital during May 2015 to May 2017 were retrospectively analyzed,They were including 45 cases with craniotomy for removing hematoma and decompressive craniectomy were regarded as control group,48 patients with stepwise decompression as the observation group; the intracranial pressure of patients immediately after operation,6 months after operation,and Glasgow coma scale( GCS) in 6 months after the operation and neurobehavioral cognitive status examination( NCSE) scores and ADL scores( Barthel index) were statistically compared between these two groups of patients with Glasgow outcome score( GOS) and intraoperative and postoperative complications. Results The postoperative intracranial pressure immediately and 6 months after the operation in patients of observation group were lower than those of patients in control group( P < 0. 05). GCS and NCSF scores and Barthel indices of patients in observation group in 6 months after operation were higher than those of control group( P < 0. 05). The good prognosis rate,GOS scores were higher than those( 4 ~ 5 points) of control group( P < 0. 05). The difference in incidence of postoperative cerebral infarction was not significant between these 2 groups( P > 0. 05),but other complications in observation group were lower than those of control group( P < 0. 05). The intraoperative and postoperative complication rates in observation group were lower than those of control group( P < 0. 05). Conclusion Stepwise controlled decompression for severe traumatic brain injury can effectively stabilize intracranial pressure and reduce intraoperative and postoperative complications,and it is of high significance in improvement of the safety and efficacy of operation.
Objective To observe the clinical effect of stepwise controlled decompression in treatment of patients with severe cerebral trauma and evaluate its clinical significance. Methods The clinical data of 93 patients with severe craniocerebral injury admitted in this hospital during May 2015 to May 2017 were retrospectively analyzed,They were including 45 cases with craniotomy for removing hematoma and decompressive craniectomy were regarded as control group,48 patients with stepwise decompression as the observation group; the intracranial pressure of patients immediately after operation,6 months after operation,and Glasgow coma scale( GCS) in 6 months after the operation and neurobehavioral cognitive status examination( NCSE) scores and ADL scores( Barthel index) were statistically compared between these two groups of patients with Glasgow outcome score( GOS) and intraoperative and postoperative complications. Results The postoperative intracranial pressure immediately and 6 months after the operation in patients of observation group were lower than those of patients in control group( P < 0. 05). GCS and NCSF scores and Barthel indices of patients in observation group in 6 months after operation were higher than those of control group( P < 0. 05). The good prognosis rate,GOS scores were higher than those( 4 ~ 5 points) of control group( P < 0. 05). The difference in incidence of postoperative cerebral infarction was not significant between these 2 groups( P > 0. 05),but other complications in observation group were lower than those of control group( P < 0. 05). The intraoperative and postoperative complication rates in observation group were lower than those of control group( P < 0. 05). Conclusion Stepwise controlled decompression for severe traumatic brain injury can effectively stabilize intracranial pressure and reduce intraoperative and postoperative complications,and it is of high significance in improvement of the safety and efficacy of operation.
引文
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[7]徐春林,冯石萍,罗杰,等.双额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀的临床探讨[J].临床和实验医学杂志,2016,15(3):237-240.
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[9]潘文勇,孟庆海,李环亭,等.控制性阶梯式减压在重型颅脑损伤手术中的应用[J].中华神经外科疾病研究杂志,2014,13(1):36-39.
[10]顾昕,朱伟一,郭俊.颅脑损伤开颅术中急性脑膨出患者院内死亡相关危险因素分析[J].临床和实验医学杂志,2017,16(6):563-566.
[11]谢贤生,刘胜初,廖驭国,等.重型颅脑损伤术中急性脑膨出情况及其影响因素分析[J].中国实用神经疾病杂志,2016,43(14):162-164.
[12]王成,经大平,孙庆,等.颅脑损伤术中急性脑膨出的相关因素分析[J].中华神经外科疾病研究杂志,2013,12(3):258-260.
[2]李鑫,刘少波,张彭.控制性减压术治疗重型、特重型颅脑损伤[J].中国微侵袭神经外科杂志,2013,18(5):219-221.
[3]王正锐,李平,高永清,等.逐步控制性减压手术治疗重型、特重型颅脑损伤[J].中华神经外科杂志,2011,27(11):1154-1156.
[4]蒋国卿,郭晓红,主编.脑卒中诊疗手册[M].北京:人民军医出版社,2014:56-188.
[5]谷晓辉,李景东,黄威,等.控制性阶梯式减压在重型颅脑损伤治疗中的应用价值探讨[J].中外医疗,2014,23:29-30.
[6]吴保浒,李光远.重型颅脑损伤术中急性脑膨出原因的探讨及手术策略[J].蚌埠医学院学报,2011,36(7):747-749.
[7]徐春林,冯石萍,罗杰,等.双额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀的临床探讨[J].临床和实验医学杂志,2016,15(3):237-240.
[8]许吉利,赵振华.大骨瓣减压术治疗129例重型颅脑损伤体会[J].中国临床医生,2013,41(4):43-44.
[9]潘文勇,孟庆海,李环亭,等.控制性阶梯式减压在重型颅脑损伤手术中的应用[J].中华神经外科疾病研究杂志,2014,13(1):36-39.
[10]顾昕,朱伟一,郭俊.颅脑损伤开颅术中急性脑膨出患者院内死亡相关危险因素分析[J].临床和实验医学杂志,2017,16(6):563-566.
[11]谢贤生,刘胜初,廖驭国,等.重型颅脑损伤术中急性脑膨出情况及其影响因素分析[J].中国实用神经疾病杂志,2016,43(14):162-164.
[12]王成,经大平,孙庆,等.颅脑损伤术中急性脑膨出的相关因素分析[J].中华神经外科疾病研究杂志,2013,12(3):258-260.