急性硬膜下血肿行单侧与双侧去骨瓣减压治疗的临床效果观察
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摘要
目的观察单、双侧去骨瓣减压治疗急性硬膜下血肿的临床效果。方法选取2015年12月至2017年12月在本院诊治的72例急性硬膜下血肿患者临床资料,按不同术式分两组,各36例,对照组行单侧去骨瓣减压术,观察组行双侧去骨瓣减压术,比较两组疗效及神经功能、并发症情况。结果观察组治疗后恢复良好比例38.89%比对照组13.89%高,比较差异有统计学意义(P<0.05);观察组术后1 d、3 d、7 d的颅内压(22.63±5.96)mmHg、(18.77±4.05)mmHg、(14.91±3.02)mmHg均比对照组小,且术后1周的NIHSS评分(5.51±0.32)分比对照组低,比较差异有统计学意义(P<0.05);观察组术后并发症发生率5.56%比对照组22.22%低,比较差异有统计学意义(P<0.05)。结论急性硬膜下血肿应用双侧去骨瓣减压术治疗能有效缓解昏迷,降低颅内压,并改善神经功能,减少术后并发症风险,促进患者良好恢复,效果显著。
Objective To observe the clinical effect of treating acute subdural hematoma with single and bilateral decompression bone removal.Methods The clinical data of 72 patients with acute subdural hematoma diagnosed and treated in our hospital from December 2015 to December2017 were selected, and divided into 2 groups according to different operative methods, with 36 cases each. The control group received unilateral decompressive bone flap decompression, and the observation group received bilateral decompressive bone flap decompression. The curative effect, neurological function and complications of the two groups were compared. Results The proportion of good recovery after treatment in the observation group was 38.89% higher than the 13.89% in the control group, and the difference was statistically significant(P<0.05).The intracranial pressure(22.63±5.96), mmHg(18.77±4.05), and mmHg(14.91±3.02) of the observation group were all smaller than the control group at 1 d, 3 d and 7 d postoperatively, and the NIHSS score(5.51±0.32) at 1 week postoperatively was lower than the control group, with statistically significant differences(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(22.22%), and the difference was statistically significant(P<0.05). Conclusion The treatment of acute subdural hematoma by bilateral decompressive craniectomy can effectively alleviate coma, reduce intracranial pressure, improve neurological function, reduce the risk of postoperative complications, and promote the patient's good recovery, with remarkable effect.
Objective To observe the clinical effect of treating acute subdural hematoma with single and bilateral decompression bone removal.Methods The clinical data of 72 patients with acute subdural hematoma diagnosed and treated in our hospital from December 2015 to December2017 were selected, and divided into 2 groups according to different operative methods, with 36 cases each. The control group received unilateral decompressive bone flap decompression, and the observation group received bilateral decompressive bone flap decompression. The curative effect, neurological function and complications of the two groups were compared. Results The proportion of good recovery after treatment in the observation group was 38.89% higher than the 13.89% in the control group, and the difference was statistically significant(P<0.05).The intracranial pressure(22.63±5.96), mmHg(18.77±4.05), and mmHg(14.91±3.02) of the observation group were all smaller than the control group at 1 d, 3 d and 7 d postoperatively, and the NIHSS score(5.51±0.32) at 1 week postoperatively was lower than the control group, with statistically significant differences(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(22.22%), and the difference was statistically significant(P<0.05). Conclusion The treatment of acute subdural hematoma by bilateral decompressive craniectomy can effectively alleviate coma, reduce intracranial pressure, improve neurological function, reduce the risk of postoperative complications, and promote the patient's good recovery, with remarkable effect.
引文
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[11]张泽立,刘文明,张源,等.双侧去骨瓣减压术治疗幕上重型颅脑创伤的疗效[J].中华神经外科杂志,2017,33(7):673-676.
[12]杜文俊,张永,杜浩,等.双侧去骨瓣减压治疗重型颅脑损伤的临床研究[J].中国实用医刊,2015,42(3):27-28.
[13]刘倩绫,罗效萍.急性硬膜下血肿合并脑疝行去骨瓣减压术96例临床疗效分析[J].中国实用神经疾病杂志,2015,(6):92-94.
[2]李青峰,罗晟,张嘉,等.标准外伤骨瓣治疗急性硬膜下血肿80例疗效分析[J].陕西医学杂志,2015(9):1157-1158.
[3]梁宇迪,邓景阳,曾志明,等.改良去骨瓣减压术治疗重型颅脑损伤的临床效果[J].当代医学,2014,20(5):6-7.
[4]黄鹏,黄鹍,谢常燕,等.丁苯酞联用血塞通注射液对急性脑梗死患者功能改善的影响[J].当代医学,2016,22(14):155-156.
[5]蒋晓明,佘晓春,王震,等.穿颅预减压治疗急性硬膜下血肿合并脑疝47例疗效观察[J].医学临床研究,2014,31(3):590-591.
[6]Ikeda Osamu,Minami Norihiko,Yamazaki Masashi,et al.Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level[J].The journal of spinal cord medicine,2015,38(2):239-244.
[7]李志红,李玉骞,柴磊,等.重型创伤性脑损伤患者去骨瓣减压术后硬膜下积液的治疗方法[J].中华创伤杂志,2016,32(7):607-611.
[8]张帅,向鹏.双侧去骨瓣减压手术对急性硬膜下血肿伴脑疝患者的临床效果评价[J].当代医学,2014,20(17):40-41.
[9]杨周,蒲景礼,莫建兵,等.单侧外伤大骨瓣减压窗手术与双侧去骨瓣减压开颅术治疗重型对冲性颅脑外伤的疗效对比[J].现代诊断与治疗,2014,(13):3023-3024.
[10]许长平.双侧去骨瓣减压开颅术改善重型对冲性颅脑外伤患者预后的效果探讨[J].系统医学,2016,1(4):27-29.
[11]张泽立,刘文明,张源,等.双侧去骨瓣减压术治疗幕上重型颅脑创伤的疗效[J].中华神经外科杂志,2017,33(7):673-676.
[12]杜文俊,张永,杜浩,等.双侧去骨瓣减压治疗重型颅脑损伤的临床研究[J].中国实用医刊,2015,42(3):27-28.
[13]刘倩绫,罗效萍.急性硬膜下血肿合并脑疝行去骨瓣减压术96例临床疗效分析[J].中国实用神经疾病杂志,2015,(6):92-94.