双侧去骨瓣减压术中脑组织医源性损伤原因分析  

Causes analysis of intraoperative cerebral tissue iatrogenic injury in bilateral decompressive craniectomy

作　　者：范晓峰[1] 黄强[1] 戴伟民[1] 揭园庆[1] 余国峰[1] 吴安[1] 吕尧[1] 李运平[1] 严欣[1] 

机构地区：[1]浙江省衢州中心医院,衢州324000

出　　处：《浙江创伤外科》2014年第6期877-880,共4页Zhejiang Journal of Traumatic Surgery

摘　　要：目的探讨基层医院双侧去骨瓣减压术中脑组织医源性损伤的发生机制。方法回顾性分析2006年6月至2012年1月,本院133例双侧去骨瓣减压术患者的临床资料,其中97例采用气钻、铣刀开颅的患者作为观察组,另36例采用手摇颅钻、线锯开颅的患者作为对照组。记录两组患者的后手术侧手术时间,对比研究两组患者的非预期再次手术率及病死率。结果观察组术后行非预期再次手术22例,其中先手术侧再次手术17例(后手术侧手术时间118±21分钟),后手术侧再次手术5例。对照组非预期再次手术15例,先手术侧再次手术12例(后手术侧手术时间144±25分钟),后手术侧再次手术3例。观察组死亡25例,对照组19例。观察组的非预期再次手术率及病死率显著低于对照组。两组的先手术侧非预期再次手术率均显著高于后手术侧。差异有统计学意义(P<0.05)。结论在双侧去骨瓣减压术中,"重力-时间"因素及后手术侧开颅时产生的暴力对先手术侧脑组织的损伤是导致术中医源性损伤的主要原因。先进手术器械的合理使用及脑保护理念的始终贯彻,能显著减少术中脑组织医源性损伤,降低术后非预期再次手术率及病死率。Objective To explore the machine-processed of cerebral tissue iatrogenic injury in bilateral decompressive craniectomy in rural hospital. Methods A restrospective analysis of clinic data of 133 patients occurring bilateral decompressive craniectomy from June 2006 to January 2012 was collected. 97 cases operated by the pneumatic drill and milling cutter were in the observation group, and the other 36 cases operated by twist gimlet and fretsaw were in the control group. The time of the posterior lateral reoperation in the 2 groups was recorded. And the unexpected reop-eration rate and mortality were compared. Results In the observation group, 25 cases died and 22 cases underwent unexpected reoperation, 17 in prior lateral （the posterior lateral reoperation 118 ±21min） and 5 in posterior lateral. in the control group, 6 cases died and 15 cases underwent unex-pected reoperation, 12 in prior lateral （the posterior lateral reoperation 144 ±25min） and 3 in posterior lateral. The observation group had significantly littler unexpected reoperation rate and mortality. The unexpected reoperation rate of prior lateral was significantly raised than that of posterior lateral in 2 groups. The difference was statistically significant （P〈0.05）. Conclusion In bilateral decompressive craniectomy, the ＂gravity -time＂ factor and the violence of posterior lateral craniectomy was the primary cause of the prior lateral cerebral tissue intraoperative iatrogenic injury. Intelligent use of the sophisticated equipment and prosecute of cerebral protection ideas can efficacious reduce cerebral tissue iatrogenic injury in bilateral de-compressive craniectomy, significantly can reduce mortality and unexpected reoperation rate.

关 键 词：医源性损伤 去骨瓣减压术 双侧 

分 类 号：R651.1[医药卫生—外科学]