重症颅脑外伤后脑积水患者采用两种分流手术方案的效果及预后恢复观察  

Observation on the effect and prognosis recovery of two shunt surgery methods in patients with severe head trauma and hydrocephalus

作　　者：袁莉 黄才权 文家智 邓滨 罗俊毅 YUAN Li;HUANG Cai-quan;WEN Jia-zhi(Department of Neurosurgery,People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture,Aba Tibetan and Qiang Autonomous Prefecture Sichuan 624000,China;Department of Neurosurgery,Sichuan Provincial People's Hospital,Chengdu Sichuan 610072,China)

机构地区：[1]四川省阿坝藏族羌族自治州人民医院神经外科,四川阿坝藏族羌族自治州624000 [2]四川省人民医院神经外科,四川成都610072

出　　处：《临床和实验医学杂志》2022年第7期726-730,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省卫生和计划生育委员会科研课题(编号:19J00359)。

摘　　要：目的探讨腰大池-腹腔分流、脑室-腹腔分流两种方案治疗重症颅脑外伤后并发脑积水患者治疗的效果差异及预后恢复。方法回顾性选取2015年1月至2021年4月四川省人民医院神经外科收治的120例重症颅脑外伤后并发脑积水患者作为研究对象。按照治疗方法不同分为两组,采用腰大池-腹腔分流术治疗的60例患者作为A组,采用脑室-腹腔分流术治疗的患者60例作为B组。统计两组患者的格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表评分(NIHSS)的变化,检测两组患者手术前后不同时间红细胞分布宽度(RDW)、纤维蛋白原(FIB)的变化,对比两组患者预后恢复及手术并发症发生情况。结果A组患者手术时间为(61.09±9.77)min,短于B组[(80.40±11.64)min],差异有统计学意义(P<0.05);两组患者住院时间比较,差异无统计学意义(P>0.05)。术后3 d,A组的GCS评分为(12.81±0.67)分,高于B组[(12.40±0.70)分],差异有统计学意义(P<0.05),术后7、14 d时两组差异无统计学意义(P>0.05)。两组患者术后1、2、4周的NIHSS评分比较,差异无统计学意义(P>0.05)。术后1周,A组患者的RDW测定值为(12.01±2.08)%,均低于B组[(14.80±2.53)%],差异有统计学意义(P<0.05);术后5周,两组患者的RDW、FIB测定值比较,差异无统计学意义(P>0.05)。随访3个月,A组与B组预后良好率比较(73.33%vs.63.33%),差异无统计学意义(P>0.05)。结论腰大池-腹腔分流术与脑室-腹腔分流术对重症颅脑外伤后并发脑积水患者效果差异不大,但是前者操作更简单,对患者神经功能早期恢复,改善其昏迷程度方面更有优势。Objective To explore the difference and prognosis recovery in the treatment effect of two schemes of lumbar cistern-abdominal shunt and ventricular-abdominal shunt in the treatment of patients with severe traumatic brain injury(sTBI)complicated with hydrocephalus.Methods A total of 120 patients with severe craniocerebral trauma and hydrocephalus who were admitted to the Department of Neurosurgery of Sichuan Provincial People's Hospital from January 2015 to April 2021 were retrospectively selected as the research objects.According to different treatment methods,they were divided into two groups,60 patients treated with lumbar peritoneal shunt as group A,and 60 patients treated with ventriculoperitoneal shunt as group B.The changes of Glasgow Coma Scale(GCS)and National Institutes of Health Stroke Scale Score(NIHSS)between the two groups were statistically analyzed;the change of red blood cell distribution width(RDW)and fibrinogen(FIB)at different times before and after surgery in the two groups were detected,and the prognosis recovery and the occurrence of surgical complications between the two groups were compared.Results The operation time of patients in group A was(61.09±9.77)min,which was shorter than that in group B[(80.40±11.64)min],and the difference was statistically significant(P<0.05).There was no significant difference in hospitalization time between the two groups(P>0.05).At 3 days after operation,the GCS score of group A was(12.81±0.67)points,which was higher than that of group B[(12.40±0.70)points],and the difference was statistically significant(P<0.05).There was no significant difference between the two groups at 7 and 14 days after operation(P>0.05).There was no significant difference in the NIHSS scores between the two groups at 1,2,and 4 weeks after surgery(P>0.05).At 1 week after operation,the RDW of in group A was(12.01±2.08)%,which was lower than that in group B[(14.80±2.53)%],and the difference was statistically significant(P<0.05).There was no significant difference in RDW and FIB bet

关 键 词：重症颅脑外伤 脑积水 腰大池-腹腔分流术 脑室-腹腔分流术 神经功能 

分 类 号：R651.15[医药卫生—外科学]