两种开颅术治疗重症颅脑外伤的效果观察

Observation of Serious Craniocerebral Trauma Treatmented by Two Different Methods of Craniotomy

目的观察标准外伤大骨瓣开颅术和常规骨瓣减压术在重症颅脑外伤治疗中的效果。方法选择2008年9月至2013年9月期间于我科收治的重症颅脑外伤患者共62例。按不同治疗术式分为A组和B组,其中A组行标准外伤大骨瓣开颅术,B组行常规骨瓣减压术。观察并记录两组患者在住院治疗期间发生意识、呼吸、心电图以及颅内压等方面的状况,对本资料中所有患者均进行随访,记录术后预后情况。结果 A组患者治疗期间意识障碍发生率为3.23%,呼吸异常发生率为9.68%,心电图异常发生率为22.58%,B组患者治疗期间意识障碍发生率为12.90%,呼吸异常发生率为22.58%,心电图异常发生率为54.84%,A组的不良情况发生率均低于B组(均P<0.05)。A组患者颅内压明显改善率为48.39%,B组患者颅内压明显改善率为25.81%,A组明显优于B组(P<0.05)。A组患者术后恢复优良率74.19%,B组术后恢复优良率51.61%,A组明显优于B组(P<0.05),A组术后中、重度残疾的发生率为16.13%,病死率为9.68%,B组术后中、重度残疾的发生率为29.03%,病死率为19.35%,A组均明显低于B组(均P<0.05)。结论采用标准外伤大骨瓣开颅术治疗重症颅脑损伤,利于彻底清除患者颅内血肿和对活动出血点的止血,解除颅内动静脉所受压力,早期恢复对脑组织的正常血供,减少因长时间缺血所导致的损伤,临床效果优于常规骨瓣减压术。

Objective To observe the effect of standard large trauma craniotomy and conventional decompressive craniectomy applied in serious craniocerebral trauma treatment. Methods 62 cases of patients with serious craniocerebral trauma treated in our department from September 2008 to 2013 were selected and divided into A group and B group by different surgical methods. Standard large trauma craniotomy was applied in A group, while conventional decompressive craniectomy applied in B group. The situations of awareness, breathe, ECG and intracranial pressure during treatment were observed and recorded. All the patients in this study were followed up and prognosis recorded. Results Incidence of consciousness during treatment in A group was 3.23%, breathing abnormalities 9.68%, ECG abnormalities 22.58%, and in B group consciousness 12.90%, breathing abnormalities 22.58%, ECG abnormalities 54.84%. The incidence of adverse events in A group was much lower than that in B group（all P〈0.05）. The rate of intracranial pressure improvement in A group was 48.39%, while 25.81% in B group, and it was higher in A group than that in B group（P〈0.05）. The rate of uneventful recovery in A group was 74.19%, while 51.61% in B group, and it was higher in A group than that in B group（P〈0.05）. Incidence of moderate or severe disability in A group was 16.13%, mortality rate was 9.68%, while in B group incidence of moderate or severe disability was 29.03%, mortality rate was 19.35%. It was lower in A group than that in B group（both P〈0.05）. Conclusion Standard large trauma craniotomy applied in serious craniocerebral trauma treatment could remove intracranial hematoma and control active bleeding point completely. The pressure intracranial arteries and veins received could be released, normal blood supply for brain tissue could be recovery early, and the damage caused by prolonged ischemia could be reduced. The effect of standard large trauma craniotomy was better than conventional decompressive craniectomy.