B型超声在重型颅脑创伤患者开颅手术中的应用

Application of B-ultrasound in craniotomy for patients with severe traumatic brain injury

目的探讨术中B型超声(B超)实时监测对重型颅脑创伤患者开颅手术的临床意义。方法将2017年3月至2019年6月行开颅血肿清除术和(或)去骨瓣减压术的64例重型颅脑创伤患者随机分为术中实时B超引导手术组(超声组,32例)和术中无实时B超引导手术组(对照组,32例),记录手术时间、术中及术后新发血肿数量、血肿清除率>90%比例、术中去骨瓣概率、二次手术概率和术后3 d Glasgow昏迷量表(GCS)评分,以Glasgow预后分级评价预后并计算预后良好率。结果超声组32例患者均于B超引导下顺利完成手术,术中B超实时监测新发血肿检出率为76%(19/25)。超声组患者血肿清除率>90%比例[84.38%(27/32)对59.38%(19/32);χ2=4.947,P=0.026]、术后3 d GCS评分[(11.38±3.54)分对(9.19±3.81)分;t=2.382,P=0.020]以及出院时预后良好率[56.25%(18/32)对31.25%(10/32);χ2=0.077,P=0.038]均高于对照组,而手术时间、术中去骨瓣概率和二次手术概率组间差异无统计学意义(均P>0.05)。结论重型颅脑创伤患者术中实时B超引导手术,可以有效改善预后。

Objective To investigate the clinical significance of intraoperative B-ultrasound realtime monitoring in craniotomy for patients with severe traumatic brain injury(sTBI).Methods From March 2017 to June 2019,64 patients with sTBI who met the admission criteria were included in the study.Craniotomy and/or decompressive craniectomy were performed.According to the application of real-time Bultrasound-guided surgery,the patients were randomly divided into 2 groups:ultrasound group(n=32)and control group(n=32).The operation time,the number of new hematoma during and after operation,the probability of bone flap removal,the probability of second operation and Glasgow Coma Scale(GCS)score were recorded.Glasgow Outcome Scale(GOS)was used to evaluate the prognosis and calculate the good prognosis rate.Results In the ultrasound group,32 cases were successfully operated under the guidance of B-ultrasound,and the detection rate of new hematoma was 76%(19/25).The rate of hematoma clearance rate>90%[84.38%(27/32)vs.59.38%(19/32);χ~2=4.947,P=0.026],GCS score at 3 d after operation(11.38±3.54 vs.9.19±3.81;t=2.382,P=0.020)and good prognosis rate at discharge[56.25%(18/32)vs.31.25%(10/32);χ~2=0.077,P=0.038]in the ultrasound group were higher than those in the control group,but there were no significant differences in the operation time,the probability of bone flap removal and the probability of second operation between 2 groups(P>0.05,for all).Conclusions Intraoperative real-time B-ultrasound-guided surgery can improve the prognosis of patients with sTBI.