无中线移位的重型颅脑外伤致急性弥漫性脑肿胀60例临床分析

Clinical treatment analysis of 60 cases with no midline shift-severe craniocerebral trauma accompanied with post-traumatic acute diffuse brain swelling

目的 探讨无中线移位的重型颅脑外伤致急性弥漫性脑肿胀（PADBS）的临床治疗方法及疗效.方法 对60例PADBS患者通过数字表法随机分为保守治疗组（n=30）和手术组（n=30）,分别给予保守治疗和颅内压监护探头置人及行去骨瓣减压手术治疗,观察两组术后恢复情况.结果 手术组在治疗7d和15 d后,GCS评分分别为（11.21±2.24）分、（12.88 ±2.31）分,明显高于保守治疗组的（7.47±1.51）分、（8.19±1.28）分（t=2.215、2.321,均P＜0.05）;术后随访显示,根据GOS评分,手术组治疗效果在术后恢复良好者（63.3％）明显高于保守治疗组（26.7％）,在术后昏迷（6.7％）和死亡（10.0％）患者明显低于保守治疗组（x2=15.721、4.172、3.84,均P＜0.05）.结论 在保守治疗基础上的颅内压监护探头置入及行去骨瓣减压治疗PADBS有助于客观评价创伤,及早发现病情变化,降低病死率.

Objective To investigate the clinical efficacy and treatment method for no midline shift-severe craniocerebral trauma accompanied with post-traumatic acute diffuse brain swelling （PADBS）. Methods 60 PADBS patients were randomly divided into conservative treatment group and operation group, 30 patients in each group. The operation group was treated with intraeranial pressure monitoring by implantation of the probe and decompressive eraniectomy, while the conservative treatment group received conservative treatment. The postoperative recovery was observed. Results The GCS scores of operation group postoperative 7d and 15d were （ 11.21 ± 2.24） and （ 12.88 ± 2.31 ）, which were obviously higher than （ 7.47 ± 1.51 ） and （ 8.19 ± 1.28 ） of the conservative treatment group （ t = 2. 215,2. 321, all P 〈 0.05 ）. Postoperative long-term follow-up results indicated that, according to GOS score, 63.3% patients in the operation group recovered well, which was significantly higher than 26.7% in the conservative treatment group. While the percent of patients with coma or dead was 6.7% and 10.0% in the operation group,which were significantly lower than the conservative treatment group （ X2 = 15. 721,4. 172,3. 84, all P 〈 0. 05 ）. Conclusion In general, PADBS could not be cured easliy, the operation methods of using intracranial pressure moni- toring and decompressive craniectomy based on conservative treatment could help to evaluate the trauma objectivly, detect the changes of disease earlier, treat in time and assess the prognosis accurately, all which would reduce the mortality.