双侧平衡去骨瓣治疗双瞳散大患者的救治经验  

Clinical experience of management for patients with bilateral mydriasis treated with bilateral decompressive craniectomy

作　　者：胡旭[1] 董吉荣[2] 王玉海[2] 徐勤义[2] 金东[2] 施栋良[2] 蔡学见[2] 

机构地区：[1]江苏大学临床医学院神经外科,江苏镇江212000 [2]解放军第101医院神经外科全军颅脑损伤救治中心,江苏无锡214000

出　　处：《中华神经外科疾病研究杂志》2011年第5期439-442,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨双侧平衡去骨瓣减压术在治疗特重型颅脑外伤致双瞳散大患者中的作用。方法对我科2005年1月至2010年12月收治的58例特重型颅脑外伤致双瞳散大手术患者进行回顾性分析,其中2005年1月至2007年9月仅行病灶侧去骨瓣减压术30例(A组),2007年10月至2010年12月采用双侧平衡去骨瓣减压术28例(B组),分析并比较两组患者颅内压、预后及并发症情况。结果采用双侧平衡去骨瓣减压术者较仅对血肿侧去骨瓣减压者颅内压下降有统计学意义(P<0.01);死亡率及预后良好率均明显好于后者(P<0.05)。结论双侧平衡去骨瓣减压术可有效降低特重型颅脑外伤致双瞳散大患者的死亡率及急性脑膨出和脑梗死的发生率,并提高其生活质量。Objective To explore the effect of bilateral decompressive craniectomy in treatment of severe traumatic brain injury patients with bilateral mydriasis.Methods Fifty-eight patients of severe traumatic brain injury with bilateral mydriasis were analyzed retrospectively from January 2005 to December 2010.A total of 30 patients were treated by unilateral decompressive craniectomy from January 2005 to September 2007（group A） and 28 cases were performed bilateral decompressive craniectomy from October 2007 to December 2010（group B）.The intracranial pressure,prognosis and complications were compared between two groups.ResultsPostoperative intracranial pressure（ICP） was significantly lower in group B than in group A（P0.01）;there is a mean lower mortality and better outcome in group B,compared with group A（P0.05）.Conclusion Bilateral decompressive craniectomy can effectively decrease the mortality due to severe brain injury,reduce the occurrence of acute encephalocele and brain infarction and improve the life quality.

关 键 词：双侧去骨瓣减压术 瞳孔散大 特重型颅脑伤 颅内压 脑膨出 

分 类 号：R651.15[医药卫生—外科学]