改良去骨瓣减压手术治疗重型脑外伤患者的临床效果  

Clinical Effect of Modified Decompressive Craniectomy Surgery on Patients with Severe Brain Injury

作　　者：谢友宝 XIE Youbao(Department of Neurosurgery,Shandong First Rehabilitation Hospital,Jinan 250000,China)

机构地区：[1]山东省第一康复医院神经外科,山东临沂276032

出　　处：《中国伤残医学》2024年第14期61-63,75,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:探讨改良去骨瓣减压手术(DC)治疗重型脑外伤患者的临床效果。方法:选取2021年1月—2023年12月山东省第一康复医院收治的60例重型脑外伤患者为研究对象,按随机数字表法将其分为对照组和研究组,各30例。对照组行常规DC治疗,研究组行改良DC治疗。比较两组围手术期指标、血清炎性因子水平、意识状态、神经功能、认知功能及并发症发生情况。结果:研究组手术时间、颅内压恢复正常时间及住院时间分别为(135.85±15.63)min、(2.49±0.45)d、(18.52±1.49)d,均短于对照组的(148.28±18.74)min、(3.27±0.48)d、(21.04±2.45)d,术中出血量为(115.22±13.59)mL,少于对照组的(129.57±15.12)mL,差异均有统计学意义(P<0.05)。术后7 d,研究组超敏C反应蛋白、白细胞介素-6、肿瘤坏死因子-α水平分别为(7.68±1.13)mg/L、(15.24±1.36)ng/L、(10.28±1.24)μg/L,均低于对照组的(9.25±1.17)mg/L、(19.71±1.89)ng/L、(13.49±1.28)μg/L,差异均有统计学意义(P<0.05)。术后1个月,研究组格拉斯哥昏迷评分法、简易精神状态检查表评分分别为(12.12±1.19)分、(28.65±0.57)分,均高于对照组的(10.63±1.08)分、(27.46±0.61)分,研究组美国国立卫生研究所卒中量表评分为(8.24±1.17)分,低于对照组的(9.87±1.22)分,差异均有统计学意义(P<0.05)。研究组并发症发生率为6.67%,低于对照组的26.67%,差异有统计学意义(P<0.05)。结论:改良DC治疗重型脑外伤效果更佳,可减轻炎症损伤,加快患者神经功能、意识状态及认知功能恢复,且并发症更少。Objective:To investigate the clinical effect of modified decompressive craniectomy(DC)surgery in the treatment of severe brain injury.Methods:A total of 60 patients with severe brain injury admitted to Shandong First Rehabilitation Hospital from January 2021 to December 2023 were selected as the study objects,and were divided into a control group and a study group according to random number table method,with 30 cases in each group.The control group received conventional DC surgery treatment,and the study group received modified DC treatment.Perioperative indexes,serum inflammatory factor levels,state of consciousness,neurological function,cognitive function and the occure of complications were compared between the two groups.Results:In the study group,the time of operation,the time of return to normal intracranial pressure and the time of hospitalization were(135.85±15.63)min,(2.49±0.45)d and(18.52±1.49)d,respectively,which were shorter than(148.28±18.74)min,(3.27±0.48)d and(21.04±2.45)d in the control group,and the intraoperative blood loss was(115.22±13.59)mL,which was less than(129.57±15.12)mL in the control group,the differences were statistically significant(P<0.05).On day 7 after operation,the levels of hypersensitive C-reactive protein,interleukin-6 and tumor necrosis factor-αin the study group were(7.68±1.13)mg/L,(15.24±1.36)g/L and(10.28±1.24)μg/L,respectively,which were lower than(9.25±1.17)mg/L,(19.71±1.89)ng/L,(13.49±1.28)μg/L in the control group,the differences were statistically significant(P<0.05).One month after surgery,the scores of Glasgow Coma Score and Minimum Mental State Examination in the study group were(12.12±1.19)points and(28.65±0.57)points,respectively,which were higher than(10.63±1.08)point and(27.46±0.61)point in the control group,the score of the National Institutes of Health Stroke Scale in the study group was(8.24±1.17)points,which was lower than(9.87±1.22)points in the control group,the differences were statistically significant(P<0.05).The incidence of co

关 键 词：重型脑外伤 改良去骨瓣减压手术 血清炎性因子 认知功能 

分 类 号：R651.1[医药卫生—外科学]