双侧平衡去骨瓣减压术对特重型颅脑伤致双瞳散大患者的救治

Management for the severe brain injured patients with bilateral mydriasis by bilateral balanced decompressive craniectomy

目的 探讨双侧平衡去骨瓣减压术在治疗特重型颅脑外伤致双瞳散大患者中的作用。方法对我科2005年1月至2010年12月收治的58例单侧损伤灶所致特重型颅脑外伤致双瞳散大手术患者进行回顾性分析，其中2005年1月至2007年9月仅行病灶侧去骨瓣减压术30例（A组），2007年10月至2010年12月采用双侧平衡去骨瓣减压术28例（B组），分析并比较两组患者颅内压、预后及并发症情况。结果采用双侧平衡去骨瓣减压术者较仅对血肿侧去骨瓣减压者颅内压下降差异有统计学意义；死亡率下降了25．2％，预后良好率上升了26．9％。结论双侧平衡去骨瓣减压术可有效降低特重型颅脑外伤致双瞳散大患者的颅内压，减少急性脑膨出和脑梗死的发生率，降低死亡率。

Objective To explore the effect of bilateral balanced decompressive craniectomy in treatment of the most severe brain injured patients with bilateral mydriasis. Methods Fifty -eight cases of the most severe brain injury due to unilateral lesions with bilateral mydriasis were analyzed retrospectively from Jan 2005 to Dec 2010. Thirty were treated by unilateral decompressive craniectomy from Jan 2305 to Sep 2007 （group A ） and 28 by bilateral balanced decompressive craniectomy from Oct 2007 to Dec 2010（group B）. The intracranial pressure, prognosis and complications were compared. Results Postoperative ICP was significantly lower in group B than group A; patients in group B had a lower mortality and better outcome than in group A. Conclusion Bilateral balanced decoInpressive craniectomy can efficiently reduce the values of ICP, occurrence of acute encephalocele and brain infarction and mortality of the most severe brain injured patients with bilateral mydriasis.