颅脑外伤大骨瓣减压术后不同时期脑切口疝发生情况研究

Study of external cerebral herniation at different times in traumatic brain injury patients after decompressive craniectomy

目的：探讨颅脑外伤行大骨瓣减压术后不同时期脑切口疝发生情况。方法回顾性分析90例行大骨瓣减压术的颅脑外伤患者临床资料，观察术后早期（术后1周以内）、中期（术后7～30 d）和晚期（术后1～6个月）脑切口疝发生率和发生程度，并比较不同时期脑膨胀患者GCS 评分和GOS 评分。结果全组脑切口疝发生率为75．55％，早期、中期和晚期膨胀发生率分别为42．22％、21．11％和12．12％，差异有统计学意义（χ2早与中＝4．312，P＜0．05；χ2中与晚＝4．523，P＜0．05；χ2早与晚＝4．543，P＜0．05），且早期脑膨胀患者膨胀程度（1．83±0．14）cm，显著高于中期和晚期患者，差异有统计学意义（t早与中＝6.301，P＜0．05；t早与晚＝6.551， P＜0．05）；早期、中期和晚期脑切口疝患者GCS评分分别为（3．22±0．41）分、（6．53±0．37）分和（12.05±0.84）分，差异有统计学意义（t早与中＝5．215，P＜0．05；t早与晚＝6．312，P＜0．05；t中与晚＝6．312，P＜0.05）；三个不同时期脑切口疝患者GOS分级之间差异具有统计学意义。结论颅脑外伤患者行大骨瓣减压术后1周脑切口疝发生率最高，膨胀程度最大；颅脑外伤患者术前GCS评分越低，其脑切口疝发生时间越早；患者脑切口疝发生时间越迟，患者预后效果越差。

Objective To explore external cerebral herniation at different times in traumatic brain injury patients after decompressive craniectomy.Methods Clinical data of 90 patients with traumatic brain injury routine＆nbsp;hemicraniectomy were analyzed,brain incisional hernia incidence and severity in early （less than a week after surgery）, medium （after 7d-30d）and late （after 1 month-June）,and compare GCS score and GOS score of different periods were observed.Results Brain incisional hernia incidence in early,middle and late was 42.22%,21.11%,12.12%with significant difference（χ2 =4.312,P〈0.05;χ2 =4.523,P〈0.05;χ2 =4.543,P〈0.05）,and the severity in early was the most（P〈0.01）;GCS scores in early,mid and late was （3.22 ±0.41）points,（6.53 ±0.37）points, （12.05 ±0.84）points with significant difference（t=5.215,P〈0.05;t=6.312,P〈0.05;t=6.312,P〈0.05）;T test showed that the difference was existed between different period of patients.Conclusion Traumatic brain injury incidence and serivity in 1 week was the most;brain hernia occurs sooner in GCS score lower patients;prognosis was worse in later external cerebral herniation patients,so GCS score and incisional hernia occurrence time is important for improving prognosis of traumatic brain injur patients.