标准大骨瓣开颅减压手术治疗重型颅脑损伤的效果  

Effect of standard large craniotomy and decompression on severe craniocerebral injury

作　　者：刘泉[1] 王新军[1] 付旭东[1] 王建业[1] 马建[1] 孟恩平[1] Liu Quan;Wang Xinjun;Fu Xudong;Wang Jianye;Ma Jian;Meng Enping(Department of Neurosurgery,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院神经外科,450052

出　　处：《临床医学》2020年第5期13-17,共5页Clinical Medicine

基　　金：2018年度河南省医学科技攻关计划项目(2018020253)。

摘　　要：目的探讨标准大骨瓣开颅减压手术治疗重型颅脑损伤患者的效果。方法选择2017年1月至2018年1月郑州大学第五附属医院收治的86例重型颅脑损伤患者,根据随机数字表法分为两组,每组43例。研究组实施标准大骨瓣开颅减压术治疗,对照组实施常规开颅减压术治疗。比较两组的治疗前后颅内压、脑组织氧摄取率、病死率、GCS评分及恢复良好率、并发症发生率、颈内静脉-桡动脉乳酸差(VADL)、脑灌注压(CCP)。结果与治疗前比较,两组患者颅内压均有所下降,且研究组患者治疗后3、7 d的颅内压水平均低于对照组(P<0.05)。研究组患者的病死率均低于对照组GCS评分及恢复良好率高于对照组(P<0.05)。研究组并发症发生率(9.3%,4/43)低于对照组(46.5%,20/43),差异有统计学意义(P<0.05)。与治疗前比较,两组患者的VADL均有所下降,研究组下降程度小于对照组(P<0.05),两组患者的CCP均有所上升,研究组上升幅度大于对照组(P<0.05)。两组患者治疗前后脑组织氧摄取率比较,差异未见统计学意义(P>0.05)。结论重型颅脑损伤患者使用标准大骨瓣开颅减压手术进行治疗,与传统开颅减压术相比,患者病死率显著降低,恢复良好率显著提升,有效改善患者预后,术野暴露充分,骨窗范围大,患者颅内高压得到充分降低,有效减少并发症的发生,值得临床积极应用。Objective To investigate the effect of standard large craniotomy and decompression surgery on severe craniocerebral injury patients.Methods A total of 86 patients with severe craniocerebral injury admitted from January 2017 to January 2018 were randomly divided into two groups,with 43 cases in each group.The study group was treated with standard large bone flap craniotomy and decompression,while the control group was treated with conventional craniotomy and decompression.Before and after treatment,the intracranial pressure,cerebral oxygen uptake rate,mortality,GCS score,recovery rate,complication rate,internal jugular vein radial artery lactate difference(vADL),cerebral perfusion pressure(CCP)were compared between the two groups.Results Compared with before treatment,the intracranial pressure of patients in both groups decreased,and the level of intracranial pressure of patients in the study group was lower than that in the control group 3 days after treatment and7 days after treatment(P<0.05).The mortality of the study group were lower than those of the control group,and GCS score and the recovery rate was higher than that of the control group(P<0.05).The incidence of complications in the study group[4 cases(9.3%)]was lower than that in the control group[20 cases(46.5%),P<0.05].Compared with the control group,VADL in both groups decreased,and the decrease degree in the study group was less than that in the control group(P<0.05).CCP in both groups increased,and the increase rate in the study group was greater than that in the control group(P<0.05).There was no significant difference in cerebral tissue oxygen uptake rate between the two groups before and after treatment(P>0.05).Conclusions Compared with traditional craniotomy decompression operation,the mortality of patients treated with standard large craniotomy decompression operation is significantly reduced,the recovery rate is significantly improved,the prognosis of patients is effectively improved,the operation field is fully exposed,the range of bone window

关 键 词：标准大骨瓣开颅减压术 传统开颅减压术 重型颅脑损伤 

分 类 号：R651.15[医药卫生—外科学]