去骨瓣减压联合小脑幕切开治疗重型、特重型颅脑损伤的应用研究  

Research on decompressive craniectomy combined with tentorium cerebelli incision in traumatic special severe and severe brain injury

作　　者：扈俊华[1] 胡承啸[1] 李玲玲 闫德祺 柴超[1] 张晓娜[1] 王凤仙[1] 高玉松[1] Hu Junhua;Hu Chengxiao;Li Lingling;Yan Deqi;Chai Chao;Zhang Xiaona;Wang Fengxian;Gao Yusong(Department of Neurosurgery,990th Hospital,the Joint Logistics Support Force,PLA,Zhumadian Henan 463000,China;Department of Hematology&Endocrinology of Neurosurgery,990th Hospital,the Joint Logistics Support Force,PLA,Zhumadian 463000,China)

机构地区：[1]中国人民解放军联勤保障部队第九九〇医院神经外科,驻马店463000 [2]中国人民解放军联勤保障部队第九九〇医院血液内分泌科,驻马店463000

出　　处：《河南外科学杂志》2020年第4期10-12,共3页Henan Journal of Surgery

基　　金：后勤科研计划(CJN14C064,CJN15J089)。

摘　　要：目的探讨去骨瓣减压联合小脑幕切开治疗创伤性重型、特重型颅脑损伤(TBI)患者的相关效果。方法将84例重型、特重型TBI患者分为观察组(去骨瓣减压术联合小脑幕切开)和对照组(去骨瓣减压术),各42例。观察2组患者的颅内压、GCS评分、GOS评分及并发症情况。结果术前及术后第7天,2组患者颅内压差异无统计学意义(P>0.05)。术后即刻及术后第1天、3天颅内压差异有统计学意义(P<0.05)。2组患者术前GCS评分差异无统计学意义(P>0.05)。术后GCS评分均较术前改善,差异有统计学意义(P<0.05)。观察组术后第1天、3天、7天的GCS评分均较对照组高,差异有统计学意义(P<0.05)。伤后3个月观察组的预后良好率高于对照组,差异有统计学意义(P<0.05)。术后观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论去骨瓣减压联合小脑幕切开术治疗重型、特重型TBI患者,并发症发生率低,可促进脑功能恢复和预后改善,救治效果良好。Objective To explore the effect of decompressive craniectomy combined with tentorium cerebelli incision in the treatment of traumatic severe and special severe craniocerebral injury.Methods Totally 84 patients with severe craniocerebral injury were equally divided into two groups:the observation group(decompressive craniectomy combined with tentorium incision)and the comparison group(decompressive craniectomy).The intracranial pressure,GCS score,GOS score and complications of the two groups of patients were observed.Results There was no statistically significant difference(P>0.05)in the intracranial pressure between the two groups before operation and 7 days after operation,but there were statistically significant differences immediately,1 day and 3 days after operation(P<0.05).There was no significant difference(P<0.05)in the GCS scores between the two groups before the operation.After the operation,the postoperative GCS scores were higher than those before the operation,and the difference was statistically significant(P<0.05).The GCS scores of the first,third,and seventh day of the observation group were higher than those of the control group,and the difference was statistically significant(P<0.05).The GOS scores in the three months after injury showed the good prognosis rate in the observation group which was higher than that of the comparison group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group was lower than that of the comparison group,the difference was statistically significant(P<0.05).Conclusion The decompressive craniectomy combined with tentorium cerebelli incision has good effects in the clinical treatment of TBI patients.It can reduce the incidence of complications,improve the prognosis and accelerate the recovery of brain function.

关 键 词：去骨瓣减压术 小脑幕切开术 创伤性重型、特重型颅脑损伤 

分 类 号：R651.15[医药卫生—外科学]