早期去骨瓣减压术治疗重型颅脑损伤29例疗效分析

Clinical effect of early decompressive craniectomy on severe traumatic brain injury

目的评价重型颅脑损伤后早期去骨瓣减压的作用。方法收集29例经早期去骨瓣减压治疗的重型颅脑损伤患者的临床和神经影像资料,根据入院时GCS评分、术前和术后中线移位及脑室脑池受压情况、骨窗面积、早期和后期神经功能恢复情况等因素进行回顾性分析。结果伤后到术前的平均时间为(4.04±1.52)h,与临床预后相关(r=0.1507,P=0.0401),术后中线明显回位(P=0.0001),环池的可见程度明显提高(P=0.0002),中线移位的减少与环池可见度的提高有明显相关性(r=0.4209,P=0.0230),同时,患者入院时的神经功能状态与临床预后明显相关(P<0.0001)。结论早期去骨瓣减压能提高重型颅脑损伤患者的预后,同时与患者颅脑损伤程度明显相关。

Objective To evaluate the clinical effect of early decompressive craniectomy on severe traumat-ic brain injury.Methods The clinical and neuroimaging records of early decompressive craniectomy in 29 patients with severe traumatic brain injury were collected.And the following information was analyzed retrospectively for each patient：GCS score on admission,pre-and postoperative midline shift,the state of the lateral ventricles and central pond,area of the craniectomy,and early and late neurological outcome.Results The average time to surgery af-ter trauma was 4.04 hours,which was related to clinical outcome（r=0.1507;P=0.0401）.The average of the midline shifts decreased after decompression（P=0.0001）.And the visibility of the central pond improved significantly after craniectomy（P=0.0002）.Decreases in the midline shifts correlated significantly with an improvement in the visibility of the central pond（r=0.4209;P=0.0230）.There was also a significant correlation between clinical status on admission and clinical outcome（P0.0001）.Conclusion Early decompressive craniectomy can improve the clinical outcome of the patients with severe traumatic brain injury,which was related with the severity of the underlying injuries.