不同方案治疗颅脑损伤去骨瓣减压术后并发进展型硬膜下积液的临床疗效观察  

Efficacy of different treatments for progressive subdural effusion after decompressive craniectomy for craniocerebral injury

作　　者：范英俊[1] 王琼芬[2] 杨中鑫[1] 刘海波[1] 张杰[1] 王恩任[1] FAN Yingjun;WANG Qiongfen;YANG Zhongxin;LIU Haibo;ZHANG Jie;WANG Enren(Department of Neurosurgery,First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan Province,610500,China;Department of Rehabilitative Medicine,First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan Province,610500,China)

机构地区：[1]成都医学院第一附属医院神经外科,成都610500 [2]成都医学院第一附属医院康复医学科,成都610500

出　　处：《第三军医大学学报》2020年第8期835-840,共6页Journal of Third Military Medical University

基　　金：四川省教育厅自然科学基金(17ZA0135)。

摘　　要：目的探讨不同方案治疗颅脑损伤患者去骨瓣减压术后并发进展型硬膜下积液的临床疗效及并发症。方法回顾性分析成都医学院第一附属医院2013年2月至2019年3月收治的65例颅脑损伤去骨瓣减压术后并发进展型硬膜下积液患者的临床及随访资料,根据不同治疗方案分为观察组和对照组。观察组34例,采用钻孔引流术或局部穿刺引流术,联合弹力绷带适当加压包扎及腰大池持续引流,对照组31例,采用钻孔引流术或局部穿刺引流术,联合弹力绷带适当加压包扎。观察两组患者硬膜下积液出现时间、头部引流管留管时间、治疗后住院时间、一次性治愈率以及各项并发症发生率,比较两组患者治疗前及治疗后3、6个月的格拉斯哥预后评分(Glasgow Outcome Scale,GOS)。结果观察组患者头部引流管留管时间、局部引流后硬膜下积液基本消失的时间及治疗后住院时间均明显短于对照组(P<0.05),且观察组一次性治愈率也明显高于对照组(P<0.05)。观察组总体并发症发生率为23.53%,对照组为48.39%,组间差异有统计学意义(P<0.05)。两组患者硬膜下积液治疗前GOS评分差异无统计学意义(P>0.05),但治疗后3个月及6个月,观察组GOS评分均明显高于对照组(P<0.05)。结论对于颅脑损伤去骨瓣减压术后并发进展型硬膜下积液的患者,采用钻孔引流或局部穿刺引流,联合弹力绷带适当加压包扎及腰大池持续引流的综合治疗方案,能提高一次性治愈率,减少总体并发症的发生率,缩短住院时间,改善患者预后。Objective To investigate the clinical efficacy and complications of different treatments for progressive subdural effusion(SDE) after decompressive craniectomy for craniocerebral injury. Methods We retrospectively analyzed the clinical and follow-up data of 65 patients with progressive SDE after decompressive craniectomy for craniocerebral injury, who were admitted in our hospital between February, 2013 and March, 2019. Thirty-four of the patients(21 male and 13 female patients) received borehole drainage or local puncture drainage combined with compression dressing with elastic bandage and continuous drainage of the lumbar cistern(observation group), and 31(17 male and 14 female patients) received borehole drainage or local puncture drainage with compression dressing with elastic bandage(control group). The occurrence time of SDE, retention time of head drainage tube, hospital stay after treatment, one-off cure rate and the incidence of complications were analyzed in the 2 groups, and the Glasgow Outcome Scale(GOS) scores of patients before and at 3 and 6 months after the treatment were compared. Results The retention time of head drainage tube, the time from local drainage to SDE disappearance and hospital stay after treatment were significantly shorter(P<0.05), and the one-off cure rate(P<0.05) was significantly higher in the observation group than in the control group. The overall incidence of complications was 23.53% in the observation group and 48.39% in the control group, showing a significant difference between the 2 groups(P<0.05). There was no significant difference in GOS scores between the 2 groups before the treatments(P>0.05), but at 3 and 6 months after the treatments, GOS scores was significantly higher in the observation group than in the control group(P<0.05). Conclusion For patients with progressive SDE after decompressive craniectomy for craniocerebral injury, combined treatment with borehole drainage or local puncture drainage, compression dressing with elastic bandage and continuous drainage

关 键 词：颅脑损伤 减压颅骨切除术 硬膜下积液 腰大池置管引流 临床疗效 

分 类 号：R615[医药卫生—外科学] R619[医药卫生—临床医学]