大骨瓣开颅术治疗急性颅脑创伤的效果观察及对患者应激反应的影响  

Observation on the effect of craniotomy with large bone flaps on acute craniocerebral trauma and its influence on stress response of patients

作　　者：熊建平[1] Xiong Jianping(Department of Neurosurgery,the First People's Hospital of Jiande,Jiande,Zhejiang 311600,China)

机构地区：[1]建德市第一人民医院神经外科,浙江省311600

出　　处：《中国基层医药》2020年第7期859-862,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:探讨大骨瓣开颅术治疗急性颅脑创伤的效果及对患者应激反应的影响。方法:选择建德市第一人民医院2015年1月至2018年12月收治的急性颅脑创伤患者80例,采用随机数字表法分为对照组40例与观察组40例。对照组患者采用常规开颅减压术,观察组患者采用大骨瓣开颅术。比较两组治疗前与治疗后2周颅内压、格拉斯哥昏迷指数(GCS评分)、应激反应指标变化,治疗后6个月预后情况,及术后并发症发生情况。结果:观察组治疗后2周颅内压(8.48±2.10)mmHg,低于对照组的(11.86±1.74)mmHg,而GCS评分(10.35±1.87)分,高于对照组的(7.69±1.15)分( t=19.434、7.663,均 P<0.05);观察组治疗后2周血清促肾上腺皮质激素(ACTH)(35.19±5.46)mg/L、皮质醇(Cor)(17.41±4.56)μg/L,均低于对照组的(48.91±4.95)mg/L、(28.93±7.48)μg/L( t=11.774、8.317,均 P<0.05);观察组治疗后6个月预后良好(60.00%)优于对照组(32.50%),差异有统计学意义(χ 2=6.084, P<0.05);观察组并发症发生率(5.00%)低于对照组(22.50%),差异有统计学意义(χ 2=5.165, P<0.05)。 结论:大骨瓣开颅术治疗急性颅脑创伤患者效果良好,且可减轻应激反应,并发症少,值得临床借鉴。Objective To investigate the effect of large bone flap craniotomy on acute craniocerebral trauma and its influence on stress response.Methods From January 2015 to December 2018,80 patients with acute craniocerebral trauma were randomly divided into control group(40 cases)and observation group(40 cases)by random number table method.The patients in the control group were treated with conventional craniotomy and decompression,while the patients in the observation group were treated with craniotomy with large bone flaps.The changes of intracranial pressure,Glasgow coma index(GCS score),stress response index,prognosis and complications after 6 months were compared between the two groups before treatment and 2 weeks after treatment.Results Two weeks after treatment,the intracranial pressure in the observation group[(8.48±2.10)mmHg]was lower than that in the control group[(11.86±1.74)mmHg],while the GCS score[(10.35±1.87)points]was higher than that in the control group[(7.69±1.15)points](t=19.434,7.663,all P<0.05).Two weeks after treatment,the serum levels of ACTH[(35.19±5.46)mg/L]and cortisol[(17.41±4.56)mg/L]in the observation group were lower than those in the control group[(48.91±4.95)mg/L and(28.93±7.48)mg/L](t=11.774,8.317,all P<0.05).Six months after treatment,the prognosis of the observation group(60.00%)was better than that of the control group(32.50%)(χ2=6.084,P<0.05).The incidence of complications of the observation group(5.00%)was lower than that of the control group(22.50%)(χ2=5.165,P<0.05).Conclusion Craniotomy with large bone flaps has good effect in the treatment of patients with acute craniocerebral trauma,and can reduce stress response and with fewer complications,which is worthy of clinical reference.

关 键 词：颅骨切开术 减压术 外科 颅脑损伤 颅内压 格拉斯哥昏迷指数 应激反应 

分 类 号：R651[医药卫生—外科学]