双额大骨瓣减压术在外伤后难治性弥漫性脑肿胀患者中的应用效果观察  

Application of bifrontal bone flap decompressive craniectomy to refractory patients with post-traumatic diffuse brain swelling

作　　者：吴晓翔[1] 

机构地区：[1]广州军区广州总医院附属157医院神经外科,广东广州510510

出　　处：《临床军医杂志》2015年第3期226-228,296,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨双额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀的临床疗效。方法选择我院2008年7月—2013年11月收治的102例弥漫性脑肿胀患者,均经过常规降颅压和脱水治疗无效后进行手术,按照随机数字表法将其随机均分为实验组51例和对照组51例,实验组采用双额大骨瓣减压术进行治疗,对照组采用双侧标准大骨瓣减压术进行治疗,比较两组患者的手术时间、出血量、骨窗面积、入院后24 h的颅内压变化以及术后GOS评分。结果实验组手术时间明显低于对照组,出血量也明显少于对照组,而骨窗面积明显大于对照组,差异均有统计学意义(P<0.05),术后的基底池评分比较无统计学差异(P>0.05)。对照组患者在入院时颅内压与治疗后24 h颅内压比较,差异无统计学意义(P>0.05),实验组患者入院时颅内压与治疗后24 h比较,差异有统计学意义(P<0.05),而治疗后24 h实验组患者颅内压要明显低于对照组,差异有统计学意义(P<0.05);两组患者术后随访实验组的总有效率要高于对照组,差异有统计学意义(P<0.05)。结论双额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀能快速有效地降低颅内压,缩短治疗时间,改善患者预后。Objective To evaluate the clinical efficacy of bifrontal bone flap decompressive craniectomy in refractory patients with post-traumatic diffuse brain swelling. Methods A total of 102 patients with post-traumatic diffuse brain swelling admitted to our hospital and failed in conventional intracranial decompression and dehydration during July 2008 and November 2013 were divided into trial group（ n = 51） and control group（ n = 51） by random number. The trial group was treated with bifrontal big bone flap decompression,and the control group with bilateral standard big bone flap decompression. The indexes,such as operation time,bleeding volume,bone window size,change in intracranial pressure（ 24 h after admission） and postoperative GOS score,were compared between the two groups. Results Operation time and bleeding volume were significantly less in the trial group than in the control group,while bone window size was significantly larger in the trial group than in the control group（ P〈0. 05）. There was no significant difference in postoperative basal cistern score between the two groups（ P〉0. 05）. In the trial group,the difference in intracranial pressure between at the time of admission and at 24 h after treatment was significant（ P〈0. 05）,while that was not in the control group（ P〉0. 05）. After treatment,the intracranial pressure of the trial group was significantly lower than that of the control group（ P〈0. 05）. According to the postoperative follow-up,total efficiency was significantly higher in the trial group than in the control group（ P〈0. 05）. Conclusion Bilateral frontal bone flap decompression in the treatment of refractory post-traumatic brain diffuse brain swelling can effectively reduce the intracranial pressure,shorten the treatment time,and improve the prognosis of patients.

关 键 词：双额大骨瓣减压术 难治性弥漫性脑肿胀 外伤后 

分 类 号：R742[医药卫生—神经病学与精神病学]