标准大骨瓣开颅手术对颅脑损伤患者的疗效及颅内压水平、并发症的改善分析

The effect of standard large bone flap craniotomy on patients with craniocerebral injury and improvement of intracranial pressure level and complications

目的:探讨标准去大骨瓣开颅减压术治疗颅脑损伤患者的临床效果。方法:选取我院收治的88例颅脑外伤患者(2016年3月~2018年3月),根据手术方式分为观察组44例和对照组44例,观察组采用标准去大骨瓣减压术治疗、对照组采用常规去骨瓣减压术治疗;对比两组手术前后的颅内压(ICP)、格拉斯哥昏迷评分(GCS)、脑功能障碍评分(DRS)的变化,术后3个月患者的格拉斯哥预后评分(GOS)及手术并发症。结果:术前,观察组和对照组的GCS评分差异无统计学意义;术后1d、术后3d、术后7d,两组患者的GCS评分均呈增高趋势;术后1d、术后3d,观察组的GCS评分高于对照组;术后1d、术后3d、术后7d,两组患者的ICP值均呈降低趋势,观察组的GCS评分低于对照组;术前,观察组和对照组的DRS评分差异无统计学意义;术后7d、术后14d,两组患者的DRS评分均呈降低趋势;术后7d、术后14d,观察组的DRS评分低于对照组;术后3个月,观察组的预后良好率72.73%高于对照组的50.00%;观察组的手术并发症率11.36%与对照组的20.45%差异无统计学显著性。结论:标准去大骨瓣开颅减压术治疗颅脑损伤能尽快缓解患者的颅内压、昏迷状况,对于改善患者的预后具有一定的意义。

Objective To explore the clinical effect of standard debulking craniotomy to treat patients with craniocerebral injury.Methods 88 patients with craniocerebral trauma admitted in our hospital(from March 2016 to March 2018)were selected and divided into 44 cases in the observation group and 44 cases in the control group according to the surgical method.The observation group was treated with standard decompression of large bone flaps,and the control group was treated with conventional decompression of bone flaps;The changes of ICP,GCS,and DRS before and after surgery were compared between the two groups,and the GOS scores and surgical complications of the patients at 3 months after surgery.Results Before the operation,there was no significant difference in GCS score between the observation group and the control group;At 1d,3d,and 7d postoperatively,the GCS scores of the two groups of patients showed an increasing trend;1d and 3d postoperatively,the GCS score of the observation group was higher than that of the control group;On the 1st postoperative day,3d postoperative day,and 7d postoperative day,the ICP values of the two groups of patients showed a decreasing trend;the GCS score of the observation group was lower than that of the control group;Before operation,there was no significant difference in DRS score between observation group and control group;At 7 days after surgery and 14 days after surgery,the DRS scores of the two groups of patients showed a decreasing trend;At 7d and 14d after operation,the DRS score of the observation group was lower than that of the control group;At 3 months after surgery,the good prognosis rate of the observation group was 72.73%higher than 50.00%of the control group;the surgical complication rate of 11.36%in the observation group was not significantly different from the control group’s 20.45%.Conclusion The treatment of craniocerebral injury with standard debulking craniotomy decompression can relieve patients’intracranial pressure and coma as soon as possible,and it has certain significance for improving the prognosis of patients.