双侧开颅手术治疗颅脑损伤临床效果及安全性评价
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摘要
目的探究双侧开颅手术治疗重型颅脑损伤的临床疗效和安全性。方法研究对象选取我院脑外科2014年3月-2017年2月期间收治的重型颅脑损伤患者75例,45例患者均接受双侧开颅手术治疗记为观察组,30例行常规开颅减压术的患者记为对照组,观察2组患者的治疗效果,并对手术风险和术后安全性进行评价。结果术前,2组患者颅内压无显著性差异(P>0.05);术后1、3、5d,2组患者颅内压均明显<术前,且观察组明显<对照组,组间比较有显著性差异(P<0.05)。术前,2组患者颅内压无显著性差异(P>0.05);术后1月,2组患者NIHSS评分均明显<术前,且观察组明显<对照组,组间比较有显著性差异(P<0.05)。观察组基本恢复率(62.22%)明显>对照组(36.67%),比较差异有统计学意义(χ~2=4.71,P=0.03)。结论双侧开颅手术对重型颅脑损伤患者颅内压释放具有显著的效果,术后一年生存率较高,值得在临床推广应用。
Objective To explore the clinical efficacy and safety of bilateral craniotomy for severe craniocerebral injury. Methods The study subjects selected 75 patients with severe craniocerebral injury who were admitted to our hospital from March 2014 to February 2017. All 45 patients underwent bilateral craniotomy and were recorded as observation group. 30 patients underwent routine craniotomy. Patients who underwent compression were recorded as a control group, and the therapeutic effects of the two groups were observed, and the risk of surgery and postoperative safety were evaluated. Results There was no significant difference in intracranial pressure between the two groups before operation(P>0.05). The intracranial pressure of the two groups was significantly lower than that of the preoperative group at 1, 3,and 5 days after operation, and the observation group was significantly lower than the control group. There was a significant difference(P<0.05). There was no significant difference in intracranial pressure between the two groups(P>0.05).The NIHSS scores of the two groups were significantly lower than those before the operation, and the observation group was significantly lower than the control group. Sexual difference(P<0.05). The basic recovery rate of the observation group(62.22%) was significantly higher than that of the control group(36.67%), and the difference was statistically significant(χ~2=4.71, P=0.03). Conclusion Bilateral craniotomy has a significant effect on intracranial pressure release in patients with severe craniocerebral injury, and the survival rate is higher in one year after surgery, which is worthy of clinical application.
Objective To explore the clinical efficacy and safety of bilateral craniotomy for severe craniocerebral injury. Methods The study subjects selected 75 patients with severe craniocerebral injury who were admitted to our hospital from March 2014 to February 2017. All 45 patients underwent bilateral craniotomy and were recorded as observation group. 30 patients underwent routine craniotomy. Patients who underwent compression were recorded as a control group, and the therapeutic effects of the two groups were observed, and the risk of surgery and postoperative safety were evaluated. Results There was no significant difference in intracranial pressure between the two groups before operation(P>0.05). The intracranial pressure of the two groups was significantly lower than that of the preoperative group at 1, 3,and 5 days after operation, and the observation group was significantly lower than the control group. There was a significant difference(P<0.05). There was no significant difference in intracranial pressure between the two groups(P>0.05).The NIHSS scores of the two groups were significantly lower than those before the operation, and the observation group was significantly lower than the control group. Sexual difference(P<0.05). The basic recovery rate of the observation group(62.22%) was significantly higher than that of the control group(36.67%), and the difference was statistically significant(χ~2=4.71, P=0.03). Conclusion Bilateral craniotomy has a significant effect on intracranial pressure release in patients with severe craniocerebral injury, and the survival rate is higher in one year after surgery, which is worthy of clinical application.
引文
[1]马敏.双侧开颅手术应用于重型颅脑损伤的临床疗效探讨[J].基层医学论坛,2018,22(23):3222-3224.
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[4]周康胜,温中华,黄乾亮.双侧开颅去骨瓣减压治疗重型颅脑损伤[J].吉林医学,2010,31(16):2494-2495.
[5]梁刚.双侧开颅手术治疗重型颅脑损伤临床疗效探究[J].医学理论与实践,2017,30(14):2075-2076.
[6]刘高峰.探讨双侧开颅手术治疗重型颅脑损伤的效果[J].临床医药文献电子杂志,2017,4(2):286,315.
[7]Lee Hyeong Rae,You Nam Kyu,Seo Sook Jin,et al.Concurrent Surgery of Craniectomy and Splenectomy as Initial Treatment in Severe Traumatic Head Injury:A Case Report.[J].Korean journal of neurotrauma,2017,13(2):141-143.
[8]Park Young-Soo,Kogeichi Yohei,Shida Yoichi,et al.Efficacy of the all-in-one therapeutic strategy for severe traumatic brain Injury:preliminary outcome and limitation.[J].Korean journal of neurotrauma,2018,14(1):6-13.
[9]李志营,夏云,郭晓鹤,等.双侧开颅不同手术时机与方式治疗外伤性多发性颅内血肿的临床效果分析[J].实用中西医结合临床,2017,17(4):102-103.
[10]Guru Dutta Satyarthee,Rajpur Yada,Luis Rafael MoscoteSalazar,et al.Mirror image extradural hematoma in elderly population:management strategy with surgical bilateral or unilateral evacuation or conservative treatment modality with literature review[J].Romanian Neurosurgery,2017,31(4):555-559.
[11]黄盛坤,黄玮,胡伟玲,等.双侧开颅不同手术时机与方式治疗外伤性多发性颅内血肿的效果评估[J].医学理论与实践,2017,30(24):3640-3641.
[2]岑茂良.双侧开颅手术治疗重型颅脑损伤76例疗效分析[J].中国实用神经疾病杂志,2016,19(17):109-110.
[3]张家富.双侧标准外伤大骨瓣开颅手术治疗重型颅脑损伤的临床效果分析[J].中国医学创新,2016,13(9):132-135.
[4]周康胜,温中华,黄乾亮.双侧开颅去骨瓣减压治疗重型颅脑损伤[J].吉林医学,2010,31(16):2494-2495.
[5]梁刚.双侧开颅手术治疗重型颅脑损伤临床疗效探究[J].医学理论与实践,2017,30(14):2075-2076.
[6]刘高峰.探讨双侧开颅手术治疗重型颅脑损伤的效果[J].临床医药文献电子杂志,2017,4(2):286,315.
[7]Lee Hyeong Rae,You Nam Kyu,Seo Sook Jin,et al.Concurrent Surgery of Craniectomy and Splenectomy as Initial Treatment in Severe Traumatic Head Injury:A Case Report.[J].Korean journal of neurotrauma,2017,13(2):141-143.
[8]Park Young-Soo,Kogeichi Yohei,Shida Yoichi,et al.Efficacy of the all-in-one therapeutic strategy for severe traumatic brain Injury:preliminary outcome and limitation.[J].Korean journal of neurotrauma,2018,14(1):6-13.
[9]李志营,夏云,郭晓鹤,等.双侧开颅不同手术时机与方式治疗外伤性多发性颅内血肿的临床效果分析[J].实用中西医结合临床,2017,17(4):102-103.
[10]Guru Dutta Satyarthee,Rajpur Yada,Luis Rafael MoscoteSalazar,et al.Mirror image extradural hematoma in elderly population:management strategy with surgical bilateral or unilateral evacuation or conservative treatment modality with literature review[J].Romanian Neurosurgery,2017,31(4):555-559.
[11]黄盛坤,黄玮,胡伟玲,等.双侧开颅不同手术时机与方式治疗外伤性多发性颅内血肿的效果评估[J].医学理论与实践,2017,30(24):3640-3641.