颅内压监测下阶梯减压与常规大骨瓣减压在重型颅脑创伤中的应用效果  

Application effect of stepped decompression under intracranial pressure monitoring and conventional large bone flap decompression in the treatment of severe craniocerebral trauma

作　　者：江敦清 陈孝菁 宋熙文 JIANG Dunqing;CHEN Xiaojing;SONG Xiwen(Department of Neurosurgery,Fengcheng Hospital of Fengxian District,Shanghai201411,China)

机构地区：[1]上海市奉贤区奉城医院神经外科,上海201411

出　　处：《中国当代医药》2022年第12期53-56,共4页China Modern Medicine

摘　　要：目的探讨颅内压监测下阶梯减压与常规大骨瓣减压在重型颅脑创伤中的应用效果。方法回顾性选取2020年1月至2021年12月上海市奉贤区奉城医院收治的60例重型颅脑创伤患者作为研究对象,按治疗方法不同分为对照组(30例)和观察组(30例)。对照组予以常规大骨瓣减压治疗,观察组予以颅内压监测下阶梯减压治疗。比较两组的手术情况、CT蝶鞍层面颞肌厚度、颅内压变化、格拉斯哥昏迷(GCS)评分、甘露醇应用情况以及并发症发生情况。结果观察组的开始减压时间、ICU住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);两组术前的CT蝶鞍层面颞肌厚度、颅内压比较,差异无统计学意义(P>0.05);两组术后的CT蝶鞍层面颞肌厚度高于术前,颅内压低于术前,差异有统计学意义(P<0.05);观察组术后的CT蝶鞍层面颞肌厚度、颅内压低于对照组,差异有统计学意义(P<0.05);两组术前的GCS评分比较,差异无统计学意义(P>0.05);两组术后的GCS评分均高于术前,差异有统计学意义(P<0.05);观察组术后的GCS评分高于对照组,差异有统计学意义(P<0.05);观察组的甘露醇应用时间短于对照组,甘露醇应用剂量低于对照组,差异有统计学意义(P<0.05);观察组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论颅内压监测下阶梯减压治疗重型颅脑创伤的效果更佳,能加快颅内压下降,减少甘露醇应用剂量,促进GCS评分恢复,缩短ICU住院时间,降低并发症风险。Objective To investigate the application effect of stepped decompression under intracranial pressure monitoring and conventional large bone flap decompression in the treatment of severe craniocerebral trauma.Methods The clinical data of 60 patients with severe craniocerebral trauma treated in Fengcheng Hospital of Fengxian District from January 2020 to December 2021 were analyzed retrospectively.According to different treatment methods,they were divided into the control group(30 cases)and the observation group(30 cases).The control group was treated with conventional large bone flap decompression,and the observation group was treated with stepped decompression under intracranial pressure monitoring.The operation condition,CT sellar temporal muscle thickness,the change of intracranial pressure,Glasgow coma scale(GCS)score,Mannitol application condition and the incidence of complications were compared between the two groups.Results The initial decompression time and ICU hospitalization time in the observation group were shorter than those in the control group,the amount of intraoperative bleeding in the observation group was less than that in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the CT sellar temporal muscle thickness and intracranial pressure between the two groups(P>0.05).The CT sellar temporal muscle thickness in the two groups were higher than those before operation,and the intracranial pressure in the two groups were lower than those before operation,the differences were statistically significant(P<0.05).The CT sellar temporal muscle thickness and intracranial pressure in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the GCS score before operation between the two groups(P>0.05).The GCS scores of the two groups after operation were higher than those before operation,and the differences were statistically significant(P<0.05).

关 键 词：重型颅脑创伤 颅内压监测下阶梯减压 常规大骨瓣减压 颅内压 并发症 

分 类 号：R651.15[医药卫生—外科学]