标准大骨瓣减压术与常规去骨瓣减压术对脑疝患者的疗效比较

Comparative Effects of Standard Large Trauma Craniotomy with Routine Decompressive Craniectomy in Treatment of Cerebral Hernia

目的探讨标准大骨瓣减压术对脑疝患者的临床疗效。方法将82例重型颅脑损伤所致脑疝患者分为两组,每组41例,观察组采用标准大骨瓣减压术治疗,对照组采用常规去骨瓣减压术治疗,1周后对比两组患者格拉斯哥昏迷评分(GCS)和颅内压,并对两组患者随访1年及神经功能缺损评分和预后良好率,应用SPSS19.0软件进行数据分析。结果术后1周,观察组患者GCS高于对照组(8.9±2.4 vs 6.0±2.0),差异有统计学意义(t=5.9434,P=0.0000),颅内压低于对照组(17.8±3.5 vs 23.9±3.1),差异有统计学意义(t=8.3540,P=0.0000;术后1年复查,观察组神经功能缺损评分低于对照组(t=9.7004,P=0.0000);预后良好率高于对照组(u=1.3148,P=0.0000)。结论标准大骨瓣减压术是治疗重型颅脑损伤所致脑疝患者最主要的措施,可彻底清除颅内血肿和坏死脑组织,有效降低颅压,使脑疝复位,挽救患者的生命。

Objective To evaluate the clinical effect of standard large trauma craniotomy on patients with cerebral hernia. Methods A total of 82 patients with cerebral hernia induced by severe craniocerebral injury were divided into two groups,41 cases in each group, the observation group was treated with standard large trauma craniotomy, the control group was treated with routine decompressive eraniectomy, GCS score and intracranial pressure of patients in two groups after 1 week was compared, and the patients were followed up for one year,and the score of neurlolgical impairment and the rate of favorable prognosis were compared, the data were analyzed by SPSS19.0 software. Results One week after operation, GCS score of the observa- tion group was higher than that of the control group （ 8.9 ＋ 2.4 vs 6.0 ＋ 2.0 ）, the difference was statistically significant（ t = 5. 9434, P = 0. 0000 ）, intracranial pressure was lower than that of the control group （ 17.8 ± 3.5 vs 23.9 ± 3.1 ）, the difference was statistically significant （ t = 8. 3540, P = 0. 0000） ; score of neurlolgi- cal impairment of the observation group was lower than that of the control group after I year（ t = 9. 7004 ,P = 0. 0000 ） ; the rate of favorable prognosis was higher than that of the control group （ u = 1.3148, P = 0. 0000 ）. Conclusion Standard large trauma craniotomy is a main measure to treat cerebral hernia induced by severe craniocerebral injury, which can remove the intracranial hematoma and necrotic brain tissue completely, decrease pressure in brain effectively, make the hernia reset, and save the lives of patients.