双侧去骨瓣减压术与传统单侧标准大骨瓣开颅减压术治疗重型颅脑损伤患者的效果比较  

Comparison of effects of bilateral decompressive craniectomy and conventional unilateral standard large trauma craniotomy in treatment of patients with severe craniocerebral injury

作　　者：石钟阳 SHI Zhongyang(Department of Neurosurgery of Wugang People’s Hospital,Pingdingshan 462500 Henan,China)

机构地区：[1]舞钢市人民医院神经外科,河南平顶山462500

出　　处：《中国民康医学》2025年第6期139-142,共4页Medical Journal of Chinese People’s Health

摘　　要：目的:比较双侧去骨瓣减压术与传统单侧标准大骨瓣开颅减压术(SLTC)治疗重型颅脑损伤患者的效果。方法:回顾性分析2021年1月至2023年1月该院收治的65例重型颅脑损伤患者临床资料,根据手术方法不同将其分为研究组(n=33)与对照组(n=32)。对照组采用传统单侧标准SLTC治疗,研究组采用双侧去骨瓣减压术治疗。比较两组预后分级[格拉斯哥预后评分(GOS)],手术前后颅内压水平、脑氧代谢指标[颈内静脉血氧饱和度(SjvO2)、脑氧摄取率(CERO2)、颈内静脉血氧含量(CjvO2)]水平、神经因子指标[神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)]水平,以及并发症发生率。结果:研究组预后分级优于对照组,差异有统计学意义(P<0.05);术后1、3、7 d,两组颅内压水平均低于术前,且研究组低于对照组,差异有统计学意义(P<0.05);术后3 d,两组SjvO2、CjvO2、CERO2等脑氧代谢指标水平均高于术前,且研究组高于对照组,差异有统计学意义(P<0.05);术后3 d,两组NSE、MBP等神经因子指标水平均低于术前,且研究组低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:双侧去骨瓣减压术治疗重型颅脑损伤患者可改善预后分级和脑氧代谢指标水平,以及降低颅内压和神经因子指标水平的效果优于传统单侧标准SLTC治疗。Objective:To compare effects of bilateral decompressive craniectomy and conventional unilateral standard large trauma craniotomy(SLTC)in treatment of patients with severe craniocerebral injury.Methods:The clinical data of 65 patients with severe craniocerebral injury admitted to this hospital from January 2021 to January 2023 were retrospectively analyzed.According to different surgical methods,they were divided into study group(n=33)and control group(n=32).The control group was treated with conventional unilateral SLTC,while the study group was treated with bilateral decompressive craniectomy.The prognosis grade[Glasgow prognosis score(GOS)],the intracranial pressure levels,the cerebral oxygen metabolism index[internal jugular venous oxygen saturation(SjvO2),cerebral oxygen uptake rate(CERO2),internal jugular venous oxygen content(CjvO2)]levels,the nerve factor[neuron-specific enolase(NSE),myelin basic protein(MBP)]levels before and after the surgery,and the incidence of complications were compared between the two groups.Results:The prognosis grade in the study group were better than those in the control group,and the differences were statistically significant(P<0.05).At 1,3 and 7 days after the surgery,the intracranial pressure levels of the two groups were lower than those before the surgery,those of the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Three days after the surgery,the levels of cerebral oxygen metabolism indexes such as SjvO2,CjvO2 and CERO2 in the two groups were higher than those before the surgery,those in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).Three days after the surgery,the levels of NSE,MBP and other nerve factors in the two groups were lower than those before the surgery,those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in t

关 键 词：重型颅脑损伤 双侧去骨瓣减压术 传统单侧标准大骨瓣开颅减压术 格拉斯哥预后评分 脑氧代谢 颅内压 神经因子 

分 类 号：R651.1[医药卫生—外科学]