神经外科患者颅脑幕上手术患者的临床研究  

CLINICAL RESEARCH OF PATIENTS WITH SUPRATENTORIAL BRAIN SURGERY IN NEUROSURGERY

作　　者：郭志波[1] 

机构地区：[1]河南省河南科技大学第二附属医院神经外科．洛阳．471000

出　　处：《现代预防医学》2011年第19期4055-4056,共2页Modern Preventive Medicine

摘　　要：[目的]探讨开颅清除血肿、去骨瓣减压加小脑幕切开术治疗外伤性小脑幕切迹疝的临床疗效。[方法]某院于2009年2月～2011年2月采用开颅清除血肿、去骨瓣减压加小脑幕切开术治疗外伤性小脑幕切迹疝,观察其脑干周围池的变化及病人死亡率,于术后2周与4周分别进行GCS评分,对比术前、术后GCS评分值。除死亡病例外,所有病人于术后24周行GCS预后评分表(GOS)进行评分。[结果]经过积极治疗,本组共死亡3例(11.11%),其中中枢性呼吸、循环衰竭死亡1例,肺部感染死亡1例。术后48h复查头颅CT,以环池宽度﹥2mm认为改善有效,本组中共有18例(66.67%)环池不同程度改善,无脑干内出血、坏死灶形成病例。27例患者术后4周GCS平均评分明显高于术前,且差异具有统计学意义(P﹤0.05)。按GOS评定疗效,本组恢复良好4例、中残7例、重残8例、植物生存5例、死亡3例。[结论]开颅清除血肿、去骨瓣减压加小脑幕切开术是外伤性小脑幕切迹疝的有效治疗方法。To investigate the effect of the craniotomy to remove the hematoma,supratentorial decompression craniectomy for traumatic incision hernia tentorial notch.[Methods]Craniotomy to remove the hematoma and supratentorial decompression craniectomy for traumatic incision hernia tentorial notch was used in our hospital from February 2009-February 2011.Observed the changes in the brain stem around the pool and patients＇ mortality.GCS score at the 2rd week and 4th weeks after surgery were compared to preoperative GCS score.Except deaths,all patients＇ GCS scores were evaluated after 24 weeks.[Results]After active treatment,3 patients in this group were dead（11.11%）,in which 1 died for central respiratory and circulatory failure,1 patient died of pulmonary infection.48 h after the surgery,head CT was reviewed,the condition that ambient cistern width﹥ 2 mm was considered as effective.In this group,18 patients（66.67%）improved in different degrees of ambient cistern without brainstem hemorrhage,necrosis formation.4 weeks after surgery,27 patients＇ average GCS score was significantly higher the than those before,and the difference was statistically significant（P﹤0.05）.Assessed by GOS efficacy,4 cases had good recovery in this group,7 cases of moderate disability,severe disability in 8 cases,5 vegetative patients,3 died.[Conclusion]Craniotomy to remove the hematoma,decompressive craniectomy is an effective treatment for tentorial incision hernia traumatic tentorial notch.

关 键 词：开颅术 去骨瓣减压 小脑幕切开术 外伤性小脑幕切迹疝 

分 类 号：R651.11[医药卫生—外科学]