颅脑创伤患者手术中恶性脑膨出的降压预防方案研究

Prevention of malignant encephalocele during craniocerebral injury surgery

目的探讨梯度降压法在颅脑创伤患者手术中预防恶性脑膨出的效果。方法该院收治的因重型颅脑损伤需开颅减压患者158例,按减压方法,分为梯度减压法90例(研究组)和常规减压法68例(对照组)。随访1年,统计术中、术后迟发血肿、术中脑膨出和病死例数,健康情况采用简明健康状况问卷(SF-36)调查,体力状况评分按卡氏评分(KPS)评分标准评价,并统计临床疗效,作对比分析。结果研究组术中或术后迟发性颅内血肿、脑膨出率和死亡率均明显低于对照组(χ2=9.495,P=0.000;χ2=4.635,P=0.023;χ2=11.598,P=0.000),其中恶性脑膨出率也明显低于对照组(χ2=3.980,P=0.035)。对照组和研究组的良好率分别为52.94%和80.00%,研究组良好率明显高于对照组(χ2=15.521,P=0.000)。研究组SF-36及KPS评分均明显高于对照组(t=2.356,P=0.015;t=2.289,P=0.026)。结论梯度减压法在颅脑损伤术中,可显著降低患者死亡和脑膨出发生率,提高临床疗效和患者术后的生存质量。

[ Objective ] To investigate the effect of gradient decompression in prevention of malignant encephalo- eele during eraniocerebral injury surgery. [Method] A total of 158 patients with severe craniocerebral injury need- ing craniotomy to reduce pressure were divided into research group （90 cases, using gradient decompression） and control group （68 cases, using conventional decompression）. One-year follow-up was made. The delayed posttraumat- ic intracranial hematoma during operation and after operation and encephalocele occurrence rate, death numbers were recorded. The 36-item short-form health survey （SF-36） was used to evaluate the health condition and karnof- sky performance status （KPS） was used to evaluate performance status. Additionally, the curative effect was also de- termined. All these results were comparatively studied. [Results ] The delayed posttraumatic intracranial hematoma during operation and after operation and encephalocele occurrence rate, death numbers of research group were all significantly lower than those of control group （X^2 = 9.495, P = 0.000;X^2 = 4.635, P = 0.023; X^2 = 11.598, P = 0.000）. And the malignant encephalocele occurrence rate of research group was significantly lower than that of con- trol group （X^2 = 3.980, P = 0.035）. The good rate of research group （80.00%） was significantly higher than that of control group （52.94%） （X^2 = 15.521, P = 0.000）. The SF-36 and KPS scores of research group were significantly higher than those of control group （t = 2.356, P = 0.015; t = 2.289, P = 0.026）. [ Conclusions ] Gradient decompres- sion in prevention of encephalocele during craniocerebral injury surgery could significantly decrease the malignant encephalocele occurrence rate and death rate, and improve curative effect and living condition.