双额叶脑挫裂伤37例临床分析  

Clinical analysis of 37 patients with bilateral frontal lobe contusion

作　　者：辛惠宁[1] 黄绳跃[1] 陶剑[1] Xin Huining;Huang Shengyue;Tao Jian(Department of Neurosurgery,Fujian Provincial Hospital,Fuzhou 350001,Fujian Province,China)

机构地区：[1]福建省立医院神经外科,福州350001

出　　处：《中国基层医药》2022年第12期1761-1764,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：福建省卫计委中青年骨干人才培养项目(2018-ZQN-2)。

摘　　要：目的探讨双额叶脑挫裂伤的临床治疗方式与效果。方法对福建省立医院2017年5月至2018年5月收治的双额叶脑挫裂伤患者37例的临床资料进行分析,并随访,根据治疗方法分为手术组(19例)和非手术组(18例),比较两组患者的临床效果。患者均进行颅内压监测,根据颅内压分为<20 mmHg、20~40 mmHg、>40 mmHg 3个阶段,比较不同颅内压水平患者的临床效果。结果手术组中,死亡1例,植物生存1例,重度残疾2例,轻度残疾8例,恢复良好7例;非手术组中,死亡4例,植物生存3例,重度残疾6例,轻度残疾3例,恢复良好2例;两组恢复良好率差异有统计学意义(χ^(2)=9.83,P<0.05);不同颅内压组恢复良好率差异有统计学意义(χ^(2)=7.97,P<0.05),颅内压>40 mmHg患者植物生存率明显高于颅内压<20 mmHg患者(50.0%比0.0%),恢复良好率明显低于颅内压<20 mmHg患者(0.0%比61.5%),差异均有统计学意义(χ^(2)=7.65、7.57,均P<0.05)。结论双额叶脑挫裂伤治疗方式的选择,主要取决于患者的临床症状、动态颅脑CT表现、动态颅内压监测值的变化情况;积极的外科手术能减少死亡、重度残疾率的发生,颅内压监测对于指导临床治疗有积极作用。Objective To investigate the treatment methods and their efficacy for bilateral frontal lobe contusion.Methods The clinical data of 37 patients with bilateral frontal lobe contusion who received treatment in Fujian Provincial Hospital between May 2017 and May 2018 were analyzed.The 37 patients were divided into surgical group(n=19)and non-surgical group(n=18)according to different treatment methods.Clinical efficacy was compared between the two groups.All patients underwent intracranial pressure monitoring.Intracerebral pressure was divided into three stages:<20 mmHg,20-40 mmHg,>40 mmHg.Clinical efficacy was compared among patients with different levels of intracranial pressure.Results In the surgical group,one patient died,one patient was in a vegetative state,two patients had severe disability,eight patients had mild disability,and seven patients well recovered.In the non-surgical group,four patients died,three patients were in a vegetative state,six patients had severe disability,three patients had mild disability,and two patients well recovered.There was significant difference in good recovery rate between the two groups(χ^(2)=9.83,P<0.05).The good recovery rate was statistically significant among patients with different levels of intracranial pressure(χ^(2)=7.97,P<0.05).The vegetative state rate in patients with>40 mmHg intracranial pressure was significantly higher than that in patients with<20 mmHg intracranial pressure(50.0%vs.0.0%,χ^(2)=7.65,P<0.05).The good recovery rate in patients with>40 mmHg intracranial pressure was significantly lower than that in patients with<20 mmHg intracranial pressure(0.0%vs.61.5%,χ^(2)=7.57,P<0.05).Conclusion The choice of treatment for bilateral frontal lobe contusion mainly depends on clinical symptoms,dynamic brain CT findings,and the changes in dynamic intracranial pressure monitoring.Active surgery can reduce the incidence of death and severe disability.Intracranial pressure monitoring has a positive role in guiding clinical treatment.

关 键 词：颅脑损伤 脑挫伤 额叶 颅内压 神经外科手术 治疗结果 格拉斯哥预后评分 预后 

分 类 号：R651.15[医药卫生—外科学]