颅内压监测下标准大骨瓣减压与常规骨瓣减压治疗重度颅脑创伤的预后研究

The study of standard large craniotomy and routine craniotomy in treatment of severe traumatic brain injuries with intracranial pressure monitoring

目的比较颅内压监测下标准大骨瓣减压术与常规骨瓣减压术治疗重度颅脑创伤的疗效。方法122例颅脑创伤患者随机分为标准大骨瓣减压组（61例）和常规骨瓣减压组（61例），两组术后第1～7天颅内压水平比较采用t检验，并发症发生情况及伤后6个月时的预后比较采用χ2检验。结果标准大骨瓣减压组术后第3—6天颅内压显著低于同日常规骨瓣减压组患者颅内压水平[（21．63±4．62）mmHg vs．（26．85±5．21）mmHg，t=2．935，P=0．003；（23．14±3．45）mmHg1）S．（23．14±3．45）mmHg，t=3．087，P=0．002；（24．32±3．65）mmHg vs．（29，32±4．72）mmHg，t=2．911，P=0．004；（22．37±5．03）mmHg vs．（26．81±3．82）mmHg，t=2．860，P=0．005]。两组间切口疝及硬膜下积液的发生率有统计学差异（1．64％ vs．11．48％，χ2=4．710，P=0．030；16．13％ vs．3．28％，χ2=4．265，P=0．039）。标准大骨瓣减压组死亡率显著低于常规骨瓣减压组（11．5％ vs 32．8％，χ2=8．038，P=0．005）。结论标准大骨瓣减压术虽可显著降低重度颅脑创伤患者的死亡率，但术后患者的生存质量较差。

Objective To compare the outcomes of standard large craniotomy with routine craniotomy in severe traumatic brain injured patients with intracranial pressure monitoring. Methods One hundred and twenty-two patients were randomly divided into standard large craniotomy group（ 61 cases ）and routine eraniotomy group（61 cases）. The first 7 days intracranial pressure levels between groups were tested by t test, and outcomes of 6 months after injury were compared by x2 test. Results The intracranial pressure levels between third day and sixth day after injury in standard large craniotomy group were significantly lower than those in routine eraniotomy group[ （ 21.63± 4.62 ） mmHg vs. （ 26. 85 ± 5.21 ） mmHg, t = 2. 935, P = 0. 003 ; （ 23.14 ± 3.45 ） mmHg vs. （ 23.14 ± 3.45 ） mmHg, t = 3.087, P = O. 002 ; （ 24. 32 ± 3.65 ） mmHg vs. （29.32 ±4. 72） mmHg,t =2. 911 ,P =0. 004; （22. 37 ~5.03） mmHg vs. （26. 81 ＋3.82） mmHg,t =2. 860, P = 0. 005 ]. The rates of incision hernia and subdural effusion were significantly different in two groups （ 1.64% vs. 11.48% ,χ2 = 4. 710,P = 0. 030;16. 13% vs. 3.28% ,χ2 = 4. 265,P = 0. 039 ）. The mortality in standard large craniotomy group were significantly lower than that in routine craniotomy group （11.5% vs. 32. 8% ,χ2 = 8. 038, P = 0. 005 ）. Conclusion The standard large craniotomy can significantly reduce the mortality of patients with severe traumatic brain injury, but the quality of life after operation is poor.