去骨瓣减压术联合单侧额颞部开颅血肿清除术治疗重型对冲性脑损伤的预后影响因素分析  

Risk factors for the prognosis of decompressive craniectomy combined with unilateral frontotemporal craniotomy and hematoma removaling for severe impact brain injury

作　　者：范文胜 侯晓鹏 张逸民 Fan Wensheng;Hou Xiaopeng;Zhang Yimin(Department of Neurosurgery,People’s Hospital of Xinzhou,Xinzhou 034000,China)

机构地区：[1]山西省忻州市人民医院神经外科,034000

出　　处：《中国实用医刊》2019年第18期87-89,共3页Chinese Journal of Practical Medicine

摘　　要：目的观察分析重型对冲性脑损伤患者采取去骨瓣减压术联合单侧额颞部开颅血肿术清除术的预后影响因素。方法选取2014年5月至2019年5月忻州市人民医院治疗的80例重型对冲性脑损伤患者,根据术后GOS评分,将其分为预后良好组(n=60)以及预后不良组(n=20),所有患者均采取去骨瓣减压术+单侧额颞部开颅血肿清除术治疗,分析影响患者预后的因素。结果预后良好组患者术前GCS评分高于预后不良组,且血肿量多<40ml,手术时机一般在伤6h内,术后一般无并发症,脑中线移位程度多<0.5cm,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,手术时机、脑中线移位程度、血肿量是影响预后的独立危险因素(P<0.05)。结论手术时机、脑中线移位程度、血肿量是影响去骨瓣减压术联合单侧额颞部开颅血肿清除术治疗的重型对冲性脑损伤患者预后的独立危险因素。Objective To analyze the risk factors for the prognosis of decompressive craniectomy combined with unilateral frontotemporal craniotomy hematoma removaling for severe impact brain injury. Methods Eighty patients with severe impact brain injury in People’s Hospital of Xinzhou from May 2014 to May 2019 were enrolled. According to the postoperative Glasgow outcome scale scores, they were divided into the good prognosis group (n=60) and the poor prognosis group (n=20). All patients underwent decompressive craniectomy + unilateral frontotemperal craniotomy for hematoma evacuation, the factors affecting the prognosis of patients were analyzed. Results The preoperative Glasgow coma scale scores of good prognosis group were significantly higher than those of the poor prognosis group(P<0.05). In good prognosis group, the amount of hematoma was less than 40 ml;operation time was generally within 6 h after injury;there was no postoperative complications, and the degree of midline shift was less than 0.5 cm;moreover the differences in the above indexes were significant between the two groups (P<0.05). Multivariate Logistic regression analysis showed that the timing of surgery, the degree of midline shift, and the amount of hematoma were independent risk factors for prognosis (P<0.05). Conclusions The timing of surgery, the degree of midline shift, and the amount of hematoma are independent risk factors for the prognosis of severe impact brain injury patients undergoing decompressive craniectomy combined with unilateral frontotemporal craniotomy hematoma removaling.

关 键 词：去骨瓣减压术 单侧额颞部开颅血肿清除术 对冲性 脑损伤 重型 

分 类 号：R651.15[医药卫生—外科学]