外伤性中心型脑疝患者临床特征与治疗方式的研究

Study of the clinical features and surgical approach of traumatic central brain herniation

目的研究外伤性中心型脑疝患者临床特征与治疗方式。方法选择颅脑外伤患者作为该研究的研究对象,分为中心型脑疝组、非中心型脑疝组和非脑疝组,并进一步根据开颅减压的方法不同将中心型脑疝患者随机分为采用标准大骨瓣减压术的观察组和常规去骨瓣减压术的对照组,观察临床特征、治疗效果及手术相关指标。结果中心型脑疝组患者发生剧烈头痛、频繁呕吐、意识障碍、癫痫发作、生命体征剧烈波动、病理征阳性的例数均明显多于其余两组;观察组临床症状缓解例数明显多于对照组,术后GCS评分、MMSE评分均明显高于对照组。结论外伤性中心型脑疝临床症状危重,采用标准大骨瓣减压术治疗疗效确切,但创伤也较大。

[ Objective ] To study the clinical features of traumatic central herniation and surgical approach. [ Methods ] Patients with traumatic brain injury were collected and divided into central herniation group, non-cen- tral herniation group and non-herniation group. Then central herniation patients were further divided into observa- tion group given standard big bone flap decompression and control group given conventional bone flap craniotomy according to the methods of decompressive craniectomy. Clinical characteristics, treatment effects and operation re- lated index were observed. [Results] Severe headache, frequent vomiting, conscious disturbance, seizures, violent fluctuation of vital signs, positive pathological sign cases of central herniation patients were significantly higher than the other two groups; clinical symptoms, postoperative GCS score, MMSE score of observation group were signifi- cantly higher than control group. [ Conclusion ] Clinical symptoms of traumatic central herniation were severe and big bone flap craniotomy can achieve better efficacy, but the trauma were larger.