重型颅脑损伤患者阶梯式减压策略下行去骨瓣减压术的应用效果及术中急性脑膨出的影响因素分析  

Application Effect of Step Decompression Strategy to Remove Bone Flap Decompression in Severe Traumatic Brain Injury and Analysis of Influencing Factors of Intraoperative Acute Encephalocele

作　　者：朱春兰 李晓玉[1] 罗静枝[1] 徐咸咸 朱晓明[2] ZHU Chun-lan;LI Xiao-yu;LUO Jing-zhi;XU Xian-xian;ZHU Xiao-ming(Operation Room,The 904 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Wuxi,Jiangsu,214000,China;Department of ICU,The 904 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Wuxi,Jiangsu,214000,China)

机构地区：[1]中国人民解放军联勤保障部队第904医院手术室,江苏无锡214000 [2]中国人民解放军联勤保障部队第904医院ICU,江苏无锡214000

出　　处：《现代生物医学进展》2022年第22期4320-4325,共6页Progress in Modern Biomedicine

基　　金：江苏省卫生计生委面上项目(H2017087)。

摘　　要：目的:观察阶梯式减压策略下行去骨瓣减压术在重型颅脑损伤中的临床应用效果,并分析患者术中急性脑膨出的影响因素。方法:回顾性分析2020年1月~2021年8月期间我院收治的103例重型颅脑损伤患者的临床资料。根据手术方式的不同分为A组(常规去骨瓣减压术,n=50)和B组(阶梯式减压策略下行去骨瓣减压术,n=53),比较两组手术相关指标、并发症发生率以及患者预后情况。此外,根据开颅术中是否出现急性脑膨出将患者分为膨出组(n=41)和未膨出组(n=62),采用多因素Logistic回归分析重型颅脑损伤患者术中急性脑膨出的影响因素。结果:B组的迟发性颅内血肿、急性脑膨出发生率低于A组,术中出血量少于A组,手术时间短于A组(P<0.05)。B组的预后良好率高于A组(P<0.05)。单因素分析结果显示:重型颅脑损伤患者术中急性脑膨出与年龄、受伤至手术时间、合并迟发性外伤性颅内血肿(DTIH)、合并对侧颅骨骨折、入院后首次格拉斯哥昏迷指数(GCS)评分、合并外伤性弥漫性脑肿胀(PADBS)、高血压病史、术前体温、术前颅内压、血小板计数(PLT)、凝血酶原时间(PT)有关(P<0.05)。多因素Logistic回归分析结果显示:合并对侧颅骨骨折、合并DTIH、合并PADBS、受伤至手术时间<3 h、入院后首次GCS评分<6分、术前颅内压偏高、术前体温偏高是重型脑损伤患者术中急性脑膨出的危险因素(P<0.05),而阶梯式减压策略下行去骨瓣减压术则是其保护因素(P<0.05)。结论:采用阶梯式减压策略下行去骨瓣减压术治疗重型颅脑损伤,可减少术中出血量,缩短手术时间,降低并发症发生率,改善患者的预后。重型颅脑损伤患者术中是否发生急性脑膨出受到合并对侧颅骨骨折、合并DTIH、合并PADBS、受伤至手术时间、入院后首次GCS评分、术前体温、术前颅内压等因素影响。Objective:To observe the clinical effect of step decompression strategy to remove bone flap decompression in severe traumatic brain injury,and to analyze the influencing factors of intraoperative acute encephalocele.Methods:103 patients with severe traumatic brain injury treated in our hospital from January 2020 to August 2021 were retrospectively selected.According to the different operation methods,the patients were divided into group A(conventional bone flap decompression,n=50)and group B(step decompression strategy,bone flap decompression,n=53).The operation related indexes,the incidence of complications and the prognosis of the two groups were compared.In addition,according to whether there was acute encephalocele during craniotomy,the patients were divided into bulge group(n=41)and non bulge group(n=62).Multivariate logistic regression was used to analyze the influencing factors of intraoperative acute encephalocele in patients with severe traumatic brain injury.Results:The operation time of group B was shorter than that of group A,the amount of intraoperative bleeding was less than that of group A,and the incidence of acute encephalocele and delayed intracranial hematoma was lower than that of group A(P<0.05).The good prognosis rate of group B was higher than that of group A(P<0.05).Univariate analysis showed that intraoperative acute encephalocele in patients with severe traumatic brain injury was related to age,time from injury to operation,DTIH,contralateral skull fracture,first GCS score after admission,PADBS,history of hypertension,preoperative body temperature,preoperative intracranial pressure,PLT and Pt(P<0.05).Multivariate logistic regression analysis showed that combined with contralateral skull fracture,DTIH,PADBS,injury to operation time<3 h,first GCS score<6 after admission,high preoperative intracranial pressure and high preoperative temperature were the risk factors of intraoperative acute encephalocele in patients with severe traumatic brain injury(P<0.05),while the step decompression strat

关 键 词：重型颅脑损伤 梯度减压术 临床疗效 急性脑膨出 影响因素 

分 类 号：R651.1[医药卫生—外科学]