重型颅脑外伤患者应用改良标准外伤大骨瓣开颅术治疗的效果分析  

Analysis on the efficacy of modified standard large trauma craniotomy in patients with severe traumatic brain injury

作　　者：董永尧[1] 石祥飞 张宗胜[1] 王德勇[1] 陈雅倩[2] DONG Yongyao;SHI Xiangfei;ZHANG Zongsheng;WANG Deyong;CHEN Yaqian(Department of Neurosurgery,the People's Hospital of Pizhou,Jiangsu,Pizhou 221300,China;Department of Pharmacy,the People's Hospital of Pizhou,Jiangsu,Pizhou 221300,China)

机构地区：[1]江苏省邳州市人民医院神经外科,江苏邳州221300 [2]江苏省邳州市人民医院药学部,江苏邳州221300

出　　处：《中国医药科学》2021年第22期165-168,共4页China Medicine And Pharmacy

摘　　要：目的探讨改良标准外伤大骨瓣开颅术对重型颅脑外伤(TBI)患者的治疗效果及安全性。方法回顾性分析2019年1月至2020年12月邳州市人民医院神经外科住院的78例重型TBI患者的临床资料,根据不同的治疗方法分为观察组(n=43)和对照组(n=35),对照组给予常规区域性骨瓣开颅术治疗,观察组应用改良标准外伤大骨瓣开颅术。记录所有患者颅内压及美国国立卫生研究院卒中量表(NIHSS)评分,观察所有患者术后并发症发生情况。随访6个月,根据格拉斯哥预后评分(GOS)对所有患者预后进行评价。结果手术前,观察组与治疗组颅内压和NIHSS评分比较,差异无统计学意义(P>0.05)。术后7 d两组颅内压和NIHSS评分均明显低于术前,且观察组术后7 d颅内压和NIHSS评分均明显低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症总发生率明显低于对照组,差异有统计学意义(16.28%vs.51.43%,χ^(2)=6.481,P=0.012)。术后随访6个月,观察组病死率和预后不良发生率明显低于对照组,差异有统计学意义(9.30%vs.40.00%,χ^(2)=8.472,P=0.000;34.88%vs.65.71%,χ^(2)=9.147,P=0.000)。结论改良标准外伤大骨瓣开颅术可明显降低重型TBI患者颅内压和NIHSS评分,改善神经功能,降低术后并发症发生率和预后不良发生率,提高患者疗效及安全性。Objective To investigate the efficacy and safety of modified standard large trauma craniotomy in patients with severe traumatic brain injury(TBI).Methods The clinical data of 78 patients with severe TBI hospitalized in the Department of Neurosurgery of The People's Hospital of Pizhou from January 2019 to December 2020 were retrospectively analyzed.These patients were divided into the observation group(n=43)and the control group(n=35)according to different treatment methods.The control group received conventional regional craniotomy,while the observation group received modified standard large trauma craniotomy.The intracranial pressure and the score of the National Institute of Health Stroke Scale(NIHSS)of all patients were recorded,and the occurrence of postoperative complications of all patients was observed.All patients were followed up for 6 months.The prognosis of all patients was evaluated by the Glasgow prognostic score(GOS).Results Before surgery,there was no statistically significant difference between the observation group and the treatment group in terms of intracranial pressure and NIHSS scores(P>0.05).At 7 days after surgery,the intracranial pressure and NIHSS scores of both groups were significantly lower than those before surgery,and those of the observation group were significantly lower than those of the control group at 7 days after surgery,with statistically significant differences(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group,with statistically significant difference(16.28%vs.51.43%,χ^(2)=6.481,P=0.012).During the 6 months of postoperative follow-up,the morbidity rate and the incidence of poor prognosis in the observation group were significantly lower than those in the control group,with statistically significant differences(9.30%vs.40.00%,χ^(2)=8.472,P=0.000;34.88%vs.65.71%,χ^(2)=9.147,P=0.000).Conclusion In the treatm ent of patients with severe TBI,modified standard large trauma craniotomy can signific

关 键 词：重型颅脑外伤 标准外伤大骨瓣开颅术 昏迷 格拉斯哥预后评分 

分 类 号：R651.15[医药卫生—外科学]