脑挫裂伤手术与非手术治疗对照研究

Cerebral contusion of surgical and non-surgical therapy randomized controlled study

目的：探讨手术或非手术治疗对脑挫裂伤患者预后的影响。方法分析收治的170例脑挫裂伤体积在40～60 ml脑挫裂伤患者的手术与否与预后关系，据伤后36 h内脑挫裂伤的体积分组，依据我们以往的临床经验，以50 ml为分组标准进行研究，36小时以内脑挫裂伤体积≤50 ml归为少量组（即A组），＞50 ml归为多量组（即B组）。 A组98例，其中手术治疗47例，非手术治疗51例。 B组72例，其中手术治疗38例，非手术治疗34例。结果对于脑挫裂伤体积在40～50 ml的A组患者，手术和非手术治疗的残、死率比较无差异；但对于脑挫裂伤体积在50～60 ml的B组患者，手术与非手术治疗的残、死率有显著差异性，与非手术者比较，手术者恢复良好率升高30．18％，致残率降低20．44％，病死率降低9．76％， GOS评分提高1．11。结论入院36 h以内脑挫裂伤体积≤50 ml时应当多以保守治疗为主，大于50 ml时应当多以手术治疗为主。

Objective To explore the effects of surgical or non-surgical treatment on the prognosis of patients with cerebral contusion .Methods To analysis the relationship of prognosis between the methods of surgical or non-surgical therapy for 170 patients of cerebral contusion with volume from 40 ml to 60 ml.Patients were divided into two groups according to the volume of cerebral contusion within 36 hours, in which cerebral contusion of less than or equal to 50 ml volume as a low volume group （Group A）,or more than 50 ml as high volume group（Group B）.In group A,there were 98 cases,of 47cases were geiven surgical treatment .While in group B, there were 72 cases, 38 underwent surgical treatment.Results In the group A,the morbidities and mortalities of patients in surgical and non-surgical treatment group were the same , while in the group B , the morbidities and mortalities of patients in surgical and non-surgical treatment group had significant difference .The patients with surgical treatment had a higher good recovery rate by 30. 18%, lower morbidities by 20.44%and mortalities by 9.76%.Conclusion Within 36 hours after injury for patients with cerebral contusion volume less than or equal to 50 ml,conservative treatment would be better choice ,while for patients with cerebral contusion volume more than 50 ml,surgery should be considered with priority .