大骨瓣开颅减压术在对冲性颅脑损伤治疗中的应用分析
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摘要
目的:探讨对冲性颅脑损伤患者采取标准外伤大骨瓣开颅减压术治疗的效果。方法:回顾性分析2014年5月-2018年5月本院接收的86例对冲性颅脑损伤患者的临床资料,按照随机数字表法分为对照组(n=43,予以常规骨瓣开颅减压术)与观察组(n=43,予以标准大骨瓣开颅减压术),观察两组的治疗情况及相关指标变化。结果:观察组患者恢复良好率明显高于对照组,差异有统计学意义(P<0.05);术后第3天,观察组患者术后GCS评分明显高于对照组,而颅内压明显低于对照组,差异均有统计学意义(P<0.05);术后,观察组对侧血肿厚度及中线移位程度均明显低于对照组,差异均有统计学意义(P<0.05);此外,术后,观察组患者白介素-4(IL-4)水平较对照组明显升高,白介素-2(IL-2)、神经元特异性烯醇化酶(NSE)以及肿瘤坏死因子-α(TNF-α)水平均明显低于对照组,差异均有统计学意义(P<0.05)。术后随访3个月,观察组并发症发生率较对照组明显降低,差异有统计学意义(P<0.05)。结论:对冲性颅脑损伤患者采取大骨瓣开颅减压术治疗的疗效明显,可减轻机体炎症反应,减少并发症的发生,具有临床推广价值。
Objective:To explore the effect of standard craniotomy with large trauma craniotomy and decompression in patients with hedged craniocerebral injury.Method:The clinical data of 86 patients with offset craniocerebral injury admitted to our hospital from May 2014 to May 2018 were retrospectively analyzed,they were divided into control group(n=43,conventional craniotomy and decompression were performed)and observation group(n=43,standard large craniotomy and decompression were performed),according to the random number table method,the changes of treatment status and related indexes in the two groups were observed.Result:The recovery rate of the observation group was significantly higher than that of the control group(P<0.05).Three days after surgery,GCS score of the observation group was significantly higher and intracranial pressure was significantly lower than those in the control group(P<0.05);after surgery,contralateral hematoma thickness and degree of midline shift of the observation group were significantly lower than those in the control group(P<0.05).After surgery,the level of IL-4 in the observation group was significantly higher than that of control group,the levels of IL-2,NSE and TNF-αin the observation group were significantly lower than those in control group(P<0.05).Postoperative follow-up for 3 months,the incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Large bone flap craniotomy for patients with hedged craniocerebral injury has obvious curative effect,it can reduce the inflammatory reaction of the body,reduce the incidence of complications,and it has clinical promotion value.
Objective:To explore the effect of standard craniotomy with large trauma craniotomy and decompression in patients with hedged craniocerebral injury.Method:The clinical data of 86 patients with offset craniocerebral injury admitted to our hospital from May 2014 to May 2018 were retrospectively analyzed,they were divided into control group(n=43,conventional craniotomy and decompression were performed)and observation group(n=43,standard large craniotomy and decompression were performed),according to the random number table method,the changes of treatment status and related indexes in the two groups were observed.Result:The recovery rate of the observation group was significantly higher than that of the control group(P<0.05).Three days after surgery,GCS score of the observation group was significantly higher and intracranial pressure was significantly lower than those in the control group(P<0.05);after surgery,contralateral hematoma thickness and degree of midline shift of the observation group were significantly lower than those in the control group(P<0.05).After surgery,the level of IL-4 in the observation group was significantly higher than that of control group,the levels of IL-2,NSE and TNF-αin the observation group were significantly lower than those in control group(P<0.05).Postoperative follow-up for 3 months,the incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Large bone flap craniotomy for patients with hedged craniocerebral injury has obvious curative effect,it can reduce the inflammatory reaction of the body,reduce the incidence of complications,and it has clinical promotion value.
引文
[1]赵磊.综合护理干预对重型颅脑损伤并脑疝患者行标准大骨瓣开颅减压术术后并发症及护理满意度的影响[J].临床研究,2017,25(5):125-127.
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[5]Wang H F,Li W C,Xu N,et al.Transoral penetrating craniocerebral injury by a bamboo chopstick in a child[J].Journal of Clinical Neuroscience,2013,20(5):746-748.
[6]巩勇.标准大骨瓣开颅减压术与常规骨瓣开颅减压术在治疗重型颅脑损伤中的价值分析[J].社区医学杂志,2014,12(23):45-47.
[7]乔俊.标准大骨瓣开颅减压术治疗重型颅脑损效果观察[J].河南外科学杂志,2016,22(6):19-20.
[8]罗日向,丘宇,兰晓艳等.标准外伤大骨瓣开颅减压术治疗对冲性重型颅脑损伤的疗效观察[J].世界临床医学,2016,10(10):39.
[9]胡云权.双侧去骨瓣与改良大骨瓣开颅减压术治疗急性颅脑损伤的疗效对比[J].医学理论与实践,2018,31(1):49-50.
[10]汤兴华.改良大骨瓣开颅减压术在重型颅脑损伤中的应用价值[J].中国实用神经疾病杂志,2014,17(3):97-98.
[11]李传友,毛青.标准外伤大骨瓣开颅术对重型颅脑损伤的疗效分析[J].重庆医学,2013,42(19):2206-2207,2211.
[12]López-Guerrero A L,Martínez-Lage J F,González-Tortosa J,et al.Pediatric crushing head injury:Biomechanics and clinical features of an uncommon type of craniocerebral trauma[J].Child’s Nervous System,2012,28(12):2033-2040.
[13]常海春.标准大骨瓣开颅减压术治疗重型颅脑损伤的临床效果分析[J].中国实用医药,2016,11(11):91-92.
[14]雷文雁.标准大骨瓣开颅减压术治疗重型颅脑损伤的临床观察[J].深圳中西医结合杂志,2015,25(4):100-101.
[15]韦力源.标准外伤大骨瓣开颅术治疗重型颅脑损伤的效果观察[J].黑龙江医药科学,2016,39(3):148-149.
[16]唐伟泰.标准大骨瓣开颅减压术治疗重度颅脑损伤的临床效果[J].深圳中西医结合杂志,2017,27(13):150-151.
[17]王德明,王湘,孙凌云,等.改良大骨瓣开颅减压术治疗急性颅脑创伤效果观察[J].西南国防医药,2015,25(5):500-502.
[18]刘福增,殷尚炯,韩树生,等.改良T形切口开颅减压术治疗重型颅脑损伤的临床效果[J].中国微侵袭神经外科杂志,2015,20(10):453-455.
[19]杨大明,甄明,柳再明,等.两种骨瓣开颅减压术治疗重型颅脑损伤的疗效对比[J].中国实用神经疾病杂志,2013,16(23):98-99.
[20]伍颖光,汤隆,陈明,等.标准外伤大骨瓣减压术治疗重型颅脑损伤疗效观察[J].华夏医学,2013,26(2):326-328.
[2]Cao Y,Qiu J,Wang B,et al.The Analysis on Risk Factors and Clinical Treatment of Craniocerebral Injury Concurrent with Acute Kidney Injury[J].Cell Biochemistry and Biophysics,2015,71(1):199-204.
[3]熊志云,艾文兵.标准大骨瓣开颅减压手术治疗重型颅脑损伤临床分析[J].中国实用神经疾病杂志,2014,17(1):78-79.
[4]程飞,程艳.标准外伤大骨瓣开颅减压术治疗额颞部重型颅脑损伤对照研究[J].中国实用神经疾病杂志,2017,20(16):44-46.
[5]Wang H F,Li W C,Xu N,et al.Transoral penetrating craniocerebral injury by a bamboo chopstick in a child[J].Journal of Clinical Neuroscience,2013,20(5):746-748.
[6]巩勇.标准大骨瓣开颅减压术与常规骨瓣开颅减压术在治疗重型颅脑损伤中的价值分析[J].社区医学杂志,2014,12(23):45-47.
[7]乔俊.标准大骨瓣开颅减压术治疗重型颅脑损效果观察[J].河南外科学杂志,2016,22(6):19-20.
[8]罗日向,丘宇,兰晓艳等.标准外伤大骨瓣开颅减压术治疗对冲性重型颅脑损伤的疗效观察[J].世界临床医学,2016,10(10):39.
[9]胡云权.双侧去骨瓣与改良大骨瓣开颅减压术治疗急性颅脑损伤的疗效对比[J].医学理论与实践,2018,31(1):49-50.
[10]汤兴华.改良大骨瓣开颅减压术在重型颅脑损伤中的应用价值[J].中国实用神经疾病杂志,2014,17(3):97-98.
[11]李传友,毛青.标准外伤大骨瓣开颅术对重型颅脑损伤的疗效分析[J].重庆医学,2013,42(19):2206-2207,2211.
[12]López-Guerrero A L,Martínez-Lage J F,González-Tortosa J,et al.Pediatric crushing head injury:Biomechanics and clinical features of an uncommon type of craniocerebral trauma[J].Child’s Nervous System,2012,28(12):2033-2040.
[13]常海春.标准大骨瓣开颅减压术治疗重型颅脑损伤的临床效果分析[J].中国实用医药,2016,11(11):91-92.
[14]雷文雁.标准大骨瓣开颅减压术治疗重型颅脑损伤的临床观察[J].深圳中西医结合杂志,2015,25(4):100-101.
[15]韦力源.标准外伤大骨瓣开颅术治疗重型颅脑损伤的效果观察[J].黑龙江医药科学,2016,39(3):148-149.
[16]唐伟泰.标准大骨瓣开颅减压术治疗重度颅脑损伤的临床效果[J].深圳中西医结合杂志,2017,27(13):150-151.
[17]王德明,王湘,孙凌云,等.改良大骨瓣开颅减压术治疗急性颅脑创伤效果观察[J].西南国防医药,2015,25(5):500-502.
[18]刘福增,殷尚炯,韩树生,等.改良T形切口开颅减压术治疗重型颅脑损伤的临床效果[J].中国微侵袭神经外科杂志,2015,20(10):453-455.
[19]杨大明,甄明,柳再明,等.两种骨瓣开颅减压术治疗重型颅脑损伤的疗效对比[J].中国实用神经疾病杂志,2013,16(23):98-99.
[20]伍颖光,汤隆,陈明,等.标准外伤大骨瓣减压术治疗重型颅脑损伤疗效观察[J].华夏医学,2013,26(2):326-328.