逐步控制减压手术治疗急性硬脑膜下血肿并脑疝疗效观察  

Observation of effect of gradually controlled decompression on acute subdural hematoma with traumatic brain hernia

作　　者：廖圣芳[1] 王玉差[1] 陈汉民[1] 余锦刚[1] 

机构地区：[1]解放军第180医院,福建泉州362000

出　　处：《现代中西医结合杂志》2013年第13期1378-1380,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨逐步控制减压手术治疗急性硬脑膜下血肿并脑疝患者的临床疗效。方法将2009年1月—2012年3月收治的89例急性硬脑膜下血肿并脑疝患者作为治疗组,采用逐步控制减压手术治疗。将2005年1月—2008年12月收治的同类患者84例作为对照组,直接行标准外伤大骨瓣减压手术。结果治疗组患者术中急性脑膨出、迟发颅内血肿及术后大面积脑梗死的发生率均低于对照组(P均<0.01);伤后3个月时按GOS评分标准评估预后,治疗组有效66例占74%,无效23例占26%;有效者觉醒时间为(15.76±3.67)d。对照组有效45例占54%,无效39例占46%;有效者觉醒时间为(21.37±4.35)d。2组比较均有极显著性差异(P均<0.01)。结论逐步控制减压手术方法简单易行,能有效减少急性硬脑膜下血肿并脑疝患者术中及术后并发症,可明显提高临床疗效,缩短昏迷时间,值得临床推广应用。Objective It is to investigate the clinical effects of gradually controlled decompression on acute subdural hema- toma with traumatic brain hernia. Methods A total of 89 patients （ treatment group） with acute subdural hematoma with trau- matic brain hernia, who were admitted to the hospital between Jan. 2009 and Mar. 2012, were treated with gradually controlled decompression. Their outcomes were compared retrospectively with that of 84 patients （ control group） who were admitted to the hospital between Jan. 2005 and Dec. 2008 and treated simply with decompression of routine standard large craniotomy. Results The incidences of acute intraoperative encephalocele, delayed intracranial hematoma and large - area cerebral infarction of treatment group were significantly lower than that of control group （ P 〈 0.01 ）. The outcomes were evaluated according to GOS scoring three months later after they suffered trauma. In treatment group, those whose outcomes were evaluated as＂ effective＂ and＂ noneffective＂ accounted for 74% and 26% respectively. Their average consciousness recovery time of those with＂ effec- tive＂ outcomes was （ 15.76 ± 3.67 ） days. In control group, the counterparts were 54% ,46% and （ 21.37 ± 4.35 ） days. There were significant differences between the two groups （ P 〈 0.01 ）. Conclusion Treatment with gradually controlled decompres- sion, which is easy to performed, not only can decrease intraoperative and postoperative complications, but also is effective on acute subdural hematoma with traumatic brain hernia. It is worth spreading.

关 键 词：颅脑损伤 急性硬脑膜下血肿 脑疝 逐步控制减压手术 

分 类 号：R651.15[医药卫生—外科学]