急诊颅脑外伤手术颅内压监护下的一期骨瓣还纳11例分析  被引量:1

Bone flap returning craniotomy guided by intracranial pressure monitoring in traumatic brain injury emergency surgery:report of eleven cases

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作  者:温良[1] 朱园润 王浩[1] 杨小锋[1] WEN Liang;ZHU Yuan-run;WANG Hao;YANG Xiao-feng(Department of Neurosurgery,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,Zhejiangf China;Derpartment of Trauma Center,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,Zhejiang,China)

机构地区:[1]浙江大学医学院附属第一医院神经外科,浙江杭州310003 [2]浙江大学医学院附属第一医院急诊创伤中心,浙江杭州310003

出  处:《加速康复外科杂志》2019年第3期115-117,共3页JOURNAL OF ENHANCED RECOVERY AFTER SURGERY

摘  要:目的:总结分析颅脑外伤急诊手术中颅内压监护下一期骨瓣还纳的手术方法及短期预后.方法:纳入2017年1月至2019年6月浙江大学医学院附属第一医院收治的因颅脑外伤接受急诊开颅手术,术中施行颅内压监护下一期骨瓣还纳的11例患者.分析患者的临床资料,观察患者的短期预后情况.结果:11例颅脑外伤急诊手术患者均存在脑挫裂伤及颅内血肿,术后重症监护室治疗时间为(4.2±4.1)d,术后住院时间为(16.3±4.7)d;术前格拉斯哥昏迷量表评分为(9.3±3.1)分,出院格拉斯哥昏迷量表评分为(11.8±1.9)分,差异有统计学意义(P=0.007).3例患者术后存在肺部感染.11例患者均未发生颅内感染或出血,无再次开颅手术病例,住院期间颅内压控制良好且无院内死亡事件.结论:颅脑外伤急诊手术中,在颅内压监护的指导下,以颅内压控制良好为前提行一期骨瓣还纳安全有效,能够加快患者的术后康复,且不会增加短期不良结局风险.Objective:Craniectomy is often required in traumatic brain injury emergency surgeries and will cause skull defect and other compKcations,which is adverse to fast recovery.Bone flap returning craniotomy guided by intracranial pressure monitoring is able to avoid second stage cranioplasty and reduce complication,therefore leads to shortened hospital stay.This case series report will present short tenn prognosis of bone flap returning craniotomy guided by intracranial pressure monitoring for clinical reference.Methods:This study included 11 patients from January 2017 to June 2019 who underwent traumatic brain injury emergency surgery in our medical center.These patients,bone flaps were returned after decompression and intracranial pressure probes insertion.Results:All 11 patients had cerebral contusion/laceration and intracranial hemorrhage.The postoperational ICU stay was 4.2±4.1 days and the hospital stay was 16.3±4.7 days.Pre-operational GCS was 9.3±3.1 and GCS before discharge was 11.8±1.9(P=0.007).Three patients had pulmonary infection after the surgery.No patient had postoperational intracranial infection or hemorrhage and no reoperation was needed.Intracranial pressure of all patients was well controlled and no patient died in hospital Condusions:In traumatic brain injuiy emergency suigeiy,bone flap returning craniotomy guided by intracranial pressure monitoring after successfill decanpression is beneficial for enhanced recovery and will not induce poor prognosis.

关 键 词:颅脑外伤 去骨瓣减压术 骨瓣还纳 颅内压监护 加速康复 

分 类 号:R651.15[医药卫生—外科学]

 

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