急诊床旁锥颅预减压联合开颅术救治外伤性硬膜下血肿并脑疝的疗效研究  

Study on clinical efficacy of bedside emergency skull-drilling pre-decompression combined with craniotomy in the treatment of traumatic subdural hematoma complicated with cerebral hernia

作　　者：吴彬冰 WU Bin-bing(Department of Neurosurgery,Puning Overseas Chinese Hospital,Puning 515300,China)

机构地区：[1]普宁华侨医院神经外科,515300

出　　处：《中国实用医药》2024年第14期73-76,共4页China Practical Medicine

摘　　要：目的研究急诊床旁锥颅预减压联合开颅术治疗外伤性硬膜下血肿并脑疝的临床效果。方法50例外伤性硬膜下血肿并脑疝患者,根据手术方式不同分为对照组和观察组,每组25例。对照组患者予以标准大骨瓣开颅硬膜下血肿清除联合去骨瓣减压术,观察组患者在对照组基础上于手术前先行急诊床旁锥颅预减压治疗。对比两组的残疾率、死亡率、并发症发生率、生存质量评分、手术及恢复指标。结果观察组残疾率、死亡率、并发症发生率分别为4.00%、0、8.00%,均低于对照组的24.00%、16.00%、36.00%(P<0.05)。术后,观察组躯体功能、机体疼痛、躯体角色、总体健康、社会功能、生命力、心理健康、情感角色评分分别为(25.14±0.98)、(9.47±0.45)、(7.72±1.16)、(22.82±1.35)、(9.14±0.98)、(21.04±1.45)、(25.76±1.77)、(5.86±1.37)分,均高于对照组的(20.25±0.97)、(7.12±0.63)、(6.04±1.09)、(17.79±1.81)、(8.25±0.57)、(17.55±1.64)、(21.66±1.68)、(4.77±1.85)分(P<0.05)。观察组手术时间(4.56±1.52)h长于对照组的(3.51±1.21)h,术中出血量(151.36±30.24)ml少于对照组的(197.81±35.62)ml,首次下床活动时间(7.36±1.45)d、术后住院时间(15.71±3.24)d短于对照组的(12.81±2.39)、(20.63±4.75)d(P<0.05)。结论急诊床旁锥颅预减压联合开颅术不仅可以迅速缓解外伤性硬膜下血肿并脑疝患者的临床症状,还可以通过清除部分外伤性硬膜下血肿,有效缩短脑组织受压时间,从而有效降低外伤性硬膜下血肿并脑疝患者的残疾率、死亡率,值得借鉴及推广。Objective To study the clinical efficacy of bedside emergency skull-drilling pre-decompression combined with craniotomy in the treatment of traumatic subdural hematoma complicated with cerebral hernia.Methods 50 patients with traumatic subdural hematoma and cerebral hernia were divided into a control group and an observation group according to different surgical methods,with 25 cases in each group.The control group was treated with standard large craniotomy subdural hematoma removal combined with decompressive craniectomy.The observation group was treated with bedside emergency skull-drilling pre-decompression before operation on the basis of control group.The disability rate,mortality rate,complication rate,quality of life score,surgery and recovery indicators were compared between the two groups.Results The disability rate,mortality rate and complication rate in the observation group were 4.00%,0 and 8.00%,which were lower than 24.00%,16.00%and 36.00%in the control group(P<0.05).After the surgery,the scores of physical function,bodily pain,role-physical,general health,social function,vitality,mental health and role-emotional in the observation group were(25.14±0.98),(9.47±0.45),(7.72±1.16),(22.82±1.35),(9.14±0.98),(21.04±1.45),(25.76±1.77)and(5.86±1.37)points,which were higher than(20.25±0.97),(7.12±0.63),(6.04±1.09),(17.79±1.81),(8.25±0.57),(17.55±1.64),(21.66±1.68)and(4.77±1.85)points in the control group(P<0.05).The surgery time of the observation group was(4.56±1.52)h,which was longer than(3.51±1.21)h of the control group;the intraoperative blood loss of the observation group(151.36±30.24)ml,which was less than(197.81±35.62)ml of the control group;the observation group had first off-bed ambulation time of(7.36±1.45)d and postoperative hospitalization time of(15.71±3.24)d,which were shorter than(12.81±2.39)and(20.63±4.75)d of the control group(P<0.05).Conclusion Bedside emergency skull-drilling pre-decompression combined with craniotomy can not only rapidly relieve the clinical sympto

关 键 词：急诊床旁锥颅预减压 开颅术 外伤性硬膜下血肿 脑疝 

分 类 号：R651.1[医药卫生—外科学]