104例双侧重型颅脑损伤患者的临床治疗

Clinical analysis of 104 patients with bilateral severe traumatic brain injury

目的 探讨双侧重型颅脑损伤（STBI）的治疗方法.方法 104例双侧STBI患者分为A、B、C3组.其中A、B组为手术组,A组（36例）行单侧开颅减压术,B组（24例）行双侧平衡开颅减压术;C组（44例）行保守治疗.并于3个月后根据GOS预后评分标准评定预后情况.结果 手术组恢复良好率优于保守组（P＜0.05）,死亡率低于保守组（P＜0.05）;B组术中脑膨出和迟发性血肿的发生率明显低于A组（P＜0.05）,其恢复良好率优于A组（P＜0.05）,但两组死亡率差异无统计学意义（P＞0.05）;B组恢复良好率优于C组（P＜0.05）,死亡率低于C组（P＜0.05）.结论 双侧平衡开颅减压术在救治双侧STBI疗效优于单侧标准外伤大骨瓣减压术和保守治疗.

Objective To explore the treatment for patients with bilateral severe traumatic brain injury（STBI）. Methods 104 patients with STBI were grouped into A（ 36 patients with unilateral cranial decompression ）, B （ 24 patients with bifrontal decompression）, C （ 44 patients with expectant treatment）. The prognoses were evaluated with Glasgow Outcome Scale （GOS） 3 months after injury in all the patients. Results The good recovery rate in the operation group was 40.0%, which was significantly higher than that in the expectant treatment group（13.6%） （P 〈 0.05） ; the death rate in the operation group was lower than that the expectant treatment group （P 〈 0.05） ; the incidence of cephalocele and tardive hematoma was significantly lower, the good recovery rate was higher in B group than that inA group （P 〈 0.05）, but there was no significant differences on death rate in two groups （P 〉 0.05） ; the good recovery rate was significantly higher, the death rate was lower in B group than that inC group （P 〈 0.05）. Conclusions The therapeutic effectof the bifrontal decompression is better than unilateral cranial decompression and expectant treatment in the treatment of STBI patients.