颅脑损伤患者治疗及预后临床分析  

Clinical analysis for the treatment and prognosis of patients with craniocerebral injury

作　　者：王海[1] 任志平[1] 张英俊[1] 李亮星[1] WANG Hai;REN Zhiping;ZHANG Yingjun(Depatment of Emergency Surgery,Shougang Hospital of Peking University,Beijing 100044,China)

机构地区：[1]北京大学首钢医院急诊外科,北京市100044

出　　处：《河北医药》2018年第5期686-689,共4页Hebei Medical Journal

摘　　要：目的探讨不同方法治疗颅脑损伤的适应证和注意事项,为临床提供科学的诊疗证据。方法选取诊治的急性颅脑损伤患者86例,所有患者根据治疗方法不同分为开颅组(28例)、微创组(30例)和保守组(28例),分别采用开颅血肿清除去骨瓣减压术、颅内血肿微创清除术及保守治疗,观察患者的预后情况。结果开颅组、微创组和保守组总有效率为89.29%、93.33%、92.86%,3组比较差异无统计学意义(P>0.05);3组并发症发生例数以及复发例数比较差异无统计学意义(P>0.05);3组患者治疗后1、3、7 d的颅内压均明显下降,其中微创组的下降程度明显优于开颅组和保守组,差异有统计学意义(P<0.05);微创组治疗后1、3、7 d的Glasgow昏迷评分均低于开颅组和保守组,差异有统计学意义(P<0.05);治疗后,开颅组和微创组的对侧血肿厚度及中线移位情况有明显变化,开颅组和微创组与保守组的血肿厚度及中线移位情况比较,差异有统计学意义(P<0.05);且微创组变化情况要大于开颅组(P<0.05)。保守组患者住院时间长于开颅组和微创组,差异有统计学意义(P<0.05)。结论抢救生命是实施手术治疗的基本原则,通过治疗,阻止患者脑疝发生与恶化,缓解颅高压症状,清除颅内血肿。症状较轻患者进行脑膜修补,临床上需要依据患者病情的具体情况针对性的选择治疗方法,从而为患者制定合理的治疗方案。Objective To investigate the indications and announcements in treatment of craniocerebral injury by different treatment methods in order to provide scientific evidence for clinical diagnosis and treatment.Methods Eighty-six patients(60 males and 26 females)with acute craniocerebral injury who were admitted and treated in our hospital from August 2010 to 2016 were enrolled in the study.According to the different treatment methods,these patients were divided into craniotomy group(n=28),minimally invasive surgery group(n=30)and conservative treatment group(n=28),and the patients in the three groups were treated by bone flap craniotomy hematoma removal decompression,minimally invasive removal of intracranial hematoma and conservative treatment,respectively.Then the therapeutic effects and prognosis of patients were observed and compared among the three groups.Results After treatment,the total effective rate in craniotomy group,minimally invasive surgery group and conservative treatment group was 89.29%,93.33%,92.86%,respectively,there was no significant difference among the three groups(P>0.05).The intracranial pressure at1d,3d,7d after treatment was obviously decreased in the three groups,moreover,the decrease degree in minimally invasive surgery group was superior to that in craniotomy group and conservative treatment group(P<0.05).Moreover the Glasgow coma scores at1d,3d,7d after treatment in minimally invasive surgery group were significantly lower than those in craniotomy group and conservative treatment group(P<0.05).After treatment,there were significant differences in contralateral hematoma thickness and midline shift circumstance between craniotomy group,minimally invasive surgery group and conservative treatment group(P<0.05),moreover,the changes in minimally invasive surgery group were more obvious than those in craniotomy group(P<0.05).In addition the length of staying in hospital in conservative treatment group was significantly longer than that in craniotomy group and minimally invasive surgery group(P<

关 键 词：颅脑损伤 血肿清除去骨瓣减压术 颅内血肿微创清除术 保守治疗 临床适应症 

分 类 号：R651.15[医药卫生—外科学]