大骨瓣减压术联合选择性亚低温治疗脑外伤的临床研究

The clinical effects of selective hypothermia and decompressive craniectomy on severe traumatic brain injury

目的研究大骨瓣减压术联合选择性亚低温治疗脑外伤的作用。方法对37例重型颅脑损伤患者分为大骨瓣减压术联合选择性亚低温治疗组(实验组)和常规开颅术后常温治疗组(对照组)。其中选择性亚低温采取亚低温治疗机给予头颈部降温,持续4天左右后自然复温。监测两组患者的颅内压、伤后6月GOS和主要并发症。结果实验组患者在24、48、72 h的颅内压分别为19.5±2.6、20.3±1.7、17.3±1.9 mmHg,而对照组分别为23.1±2.1、20.1±1.5、20.7±1.4 mmHg,在24、72 h前者较后者明显降低(P<0.05)。两组患者硬膜下积液发生率分别为43.8%、9.5%,6月后预后较佳率(GOS评分4-5分)分别为81.3%、47.6%,治疗组均显著高于对照组(P<0.05)。结论大骨瓣减压术联合选择性亚低温在重型颅脑损伤病人中有降低硬膜外压力和改善预后的作用,但增加了硬膜下积液的并发症。

Objective To investigate the clinical effects of selective hypothermia and decompressive craniectomy （DC） on severe traumatic brain injury （sTBI）. Methods Methods 37 patients with sTBI were divided into 2 groups： the therapeu- tic group （ selective hypothermia with DC, n -- 16 ） and the normothermia control group （ n= 21 ）. Selective hypothermia had been achieved by head and neck cooling for 4 days with natural warming, The intracranial pressure, good neurological outcome （ Glasgow Outcome Scale score of 4 to 5） rates in 6 months after injury and main complications were detected. Results At 24, 48 and 72 hr after injury, the mean intracranial pressure （ICP） value of the patients in the therapeutic group was lower than that of in the control group（19.5 ± 2.6, 20.3 ± 1.7 and 17.3 ± 1.9 mmHg, versus 23.1 ± 2.1, 20.1 ± 1.5, and 20.7 ± 1.4 mmHg, respectively, P 〈 0. 05）. Good neurological outcome （ Glasgow Outcome Scale score of 4 to 5） rates in 6 months after injury were 81.3% in the therapeutic group and 47.6% in the control group respectively （P 〈 0. 05）. Whereas, there were more cases complicated with subdural effusion in the therapeutic group than those in the control group （43.8% and 9.5% , respectively, P 〈 O. 05）. Conclusion Selective hypothermia and DC in sTBI is a safe and effective method, which can reduce ICP and improve prognosis. However, it increases the incidence of subdural effusion in sTB1.