标准外伤大骨瓣联合显微手术治疗SHI的疗效观察  

Curative effect of standard large trauma craniotomy combined with microsurgery on SHI

作　　者：段荣军 李卫东 何庆璋 丁源 Duan Rongjun;Li Weidong;He Qingzhang;Ding Yuan(Neurosurgery Department,Wuhu NO.1 People's Hospital 241000)

机构地区：[1]芜湖市第一人民医院,神经外科241000

出　　处：《现代科学仪器》2021年第3期117-121,共5页Modern Scientific Instruments

摘　　要：目的观察联合标准外伤大骨瓣减压与显微手术治疗重型颅脑损伤(SHI)的效果。方法回顾性抽选2016年2月~2020年6月本院80例SHI患者的临床各项档案,以手术方法不同,划分成不同组:观察组(34例)、对照组(46例),对照组患者实施标准外伤大骨瓣减压术,观察组患者在对照组的基础上联合显微手术治疗。对两组手术前后颅内压(ICP)和格拉斯哥昏迷评分法(GCS)变化以及血清神经因子水平、临床恢复进程、并发症等资料进行统计与对比。结果术后3d,观察组患者ICP为(27.21±3.12)mmHg,明显低于对照组的(31.59±3.46)mmHg(P<0.05)。术后7d,观察组的神经元特异性烯醇化酶(NSE)指标(13.86±2.32)μg/L、髓鞘碱性蛋白(MBP)指标(6.53±1.09)μg/L均明显低于对照组(16.89±3.15)μg/L、(8.15±1.17)μg/L(P<0.05);术后14d,观察组的GCS评分(10.19±2.87)分明显高于对照组(8.23±2.97)分(P<0.05);术后6月,观察组患者神经功能评分[日常生活活动能力(Barthel)量表、认知功能(LOCTA)量表]均≥3级的比例(62.50%)明显高于对照组(38.10%)(P<0.05)。观察组预后良好率(55.88%)、并发症发生率(15.63%)依次高于对照组(28.26%)、(38.10%)(P<0.05)。结论与仅实施标准外伤大骨瓣减压术相比较,联合显微手术可进一步提高SHI手术治疗效果与预后恢复水平,减轻预后不良风险,可作为临床推荐的治疗方案之一。Objective To observe the effects of combined with standard large trauma craniotomy and microsurgery in treatment of severe craniocerebral injury(SHI).Methods The clinical archives of 80 SHI patients in our hospital from February 2016 to June 2020 were selected retrospectively,and divided into different groups according to different surgical methods:observation group(34 cases),control group(46 cases),control Patients in the group underwent standard trauma decompression of large bone flaps,and patients in the observation group were treated with microsurgery on the basis of the control group.Statistics and comparison of the changes in intracranial pressure(ICP)and Glasgow coma score(GCS),serum neurological factor levels,clinical recovery effects,and complications of the two groups before and after surgery were performed.Results 3d after operation,ICP in the observation group was(27.21±3.12)mmHg,significantly lower than(31.59±3.46)mmHg in the control group(P<0.05).7d after operation,the neuron-specific enolase(NSE)index(13.86±2.32)μg/L and the myelin basic protein(MBP)index(6.53±1.09)μg/L of the ob servation group were significantly lower than tho se of the control group(16.89±3.15)μg/L,(8.15±1.17)μg/L(P<0.05).14d after operation,the GCS score(10.19±2.87)points of the observation group was significantly higher than that of the control group(8.23±2.97)points(P<0.05).6 months after operation,the proportion of patients with neurological function scores[activity of daily living(Barthel)scale,cognitive function(LOCTA)scale]of the observation group was>3 grade(62.50%),significantly higher than that of the control group(38.10%)(P<0.05).The excellent prognosis rate(55.88%)and the complication rate(15.63%)of the observation group were higher than those of the control group(28.26%)and(38.10%)(P<0.05).Conclusion Compared with standard trauma decompression of large bone flaps,combined microsurgery can further improve the treatment effect and prognosis recovery of SHI surgery,reduce the risk of poor prognosis,and can

关 键 词：SHI 标准外伤大骨瓣减压术 显微手术 

分 类 号：R47[医药卫生—护理学]