标准大骨瓣开颅血肿清除对重度颅脑外伤侧裂区损伤致单侧脑肿胀的疗效观察

Effectiveness of Standard Large Trauma Craniotomy for Hematoma Removal in Treating Unilateral Brain Swelling following Sylvian Fissure Damage of Severe Brain Injury

目的探讨标准大骨瓣开颅血肿清除去大骨瓣减压术对重度颅脑外伤侧裂区损伤致单侧脑肿胀的疗效。方法 57例重度颅脑外伤侧裂区损伤致单侧脑肿胀患者随机分成观察组(32例)和对照组(25例),分别采用标准和常规大骨瓣开颅血肿清除术治疗。观察并比较两组患者术后的格拉斯哥评分(GCS)、颅内压(ICP)、脑水肿体积、中线移位情况和生存率。结果观察组术后3d和7d时评分GCS明显高于对照组,而ICP、脑水肿体积和中线移位均明显少于对照组,差异有统计学意义(P<0.05);术后随访1年,观察组生存率为75%,明显高于对照组的48%,差异有统计学意义(χ2=4.39,P<0.05)。结论标准大骨瓣开颅血肿清除去大骨瓣减压术可以明显改善重度颅脑外伤侧裂区损伤致单侧脑肿胀患者的预后,降低病死率。

Objective To explore the effectiveness of standard large trauma craniotomy for hematoma removal in treating unilateral brain swelling following sylvian fissure damage of severe brain injury.Methods Totally 57 patients with severe brain injury and sylvian fissure damage with unilateral brain welling were randomly divided into observation group（n=32;received standard large trauma craniotomy for hematoma removal）and control group（n=25;received conventional large trauma craniotomy for hematoma removal）.GCS scores,intracranial pressure（ICP）,cerebral edema volume,midline shift,and survival rate were compared between these two groups.Results The 3-day and 7-day GCS scores were significantly higher and the the ICP,cerebral edema volume,and midline shift were significantly lower in the observation group than in control group（all P〈0.05）.The 1-year survival rate was 75% in the observation group,which was significantly higher than that（48%）in control group（χ^2=4.39,P〈0.05）.Conclusion The standard large trauma craniotomy for hematoma removal can effectively improve the prognosis and decrease the case-fatality rate in patients with unilateral brain swelling following sylvian fissure damage of severe brain injury.