标准大骨瓣开颅减压术联合颅内压监测在重型颅脑损伤中的应用及对预后的影响

Clinical effect and prognosis evaluation of standard large trauma craniectomy combined with intracranial pressure monitoring for severe traumatic brain injury

目的：探讨大骨瓣开颅减压术联合颅内压监测（ICP）在重型颅脑损伤（STBI）中的应用，以及对患者预后的影响。方法根据是否行颅内压监测，将80例STBI患者分成2组。常规组（ n ＝40例）采用标准外伤大骨瓣开颅减压术治疗，监测组（ n ＝40例）采用标准外伤大骨瓣开颅减压术联合术后ICP治疗。比较2组手术前后颅内压变化、格拉斯哥昏迷评分（ GCS）变化、预后及术后并发症发生情况。结果术后3、7 d监测组患者的颅内压较常规组下降明显（ t ＝2．17、7．34， P ＜0．05），且监测组优于常规组（ t ＝2．17、7．34， P ＜0．05）。与术前比较2组术后28 d GCS均有改善（0．60、3．84， P ＜0．05），且术后28 d监测组患者的GCS评分改善优于常规组（ t ＝3．67， P ＜0．05）；术后3个月的格拉斯哥预后评分GOS显示监测组的预后明显优于常规组（ z ＝2．00， P ＜0．05）；术后6个月监测组电解质紊乱的发生率为333．％，显著低于常规组的60．0％（χ2＝4．09， P ＜0．05）。结论标准外伤性大骨瓣开颅减压术联合ICP治疗STBI可提高救治的成功率，改善预后。

Objective To explore the effect and prognosis of standard large trauma craniectomy combined with in -tracranial pressure （ICP） monitoring for severe traumatic brain injury （STBI）.Methods According to whether received ICPmonitoring, 80 patients with STBI were randomly and equally divided into two groups .Routine group （ n =40） was treatedwith standard large trauma craniectomy, and monitoring group （ n =40） was treated with standard large trauma craniectomycombined with ICP monitoring.The change of intracranial pressure before and after operation, Glasgow coma score （GCS）changes, prognosis and post operative complications were compared.Results The intracranial pressure at 3rd day, 7th dayafter operation in monitoring group was significantly decreased compared to those in routine group （ t =2.17, t =7.34, P 〈0.05）, and the GCS score were improved in both groups after operation, at 28th day after operation,monitoring group was improvedmore obviously than the routine group （ t =3.67,P 〈0.05）.The GCS score at 3rd month after operation showed thatthe prognosis in monitoring group was significantly better than that in routine group （ t =2.00, P 〈0.05）.The incidence ofelectrolyte disturbance in monitoring group and routine group at 6 months after surgery was 33.3% and 60.0% respectivelywith statistical significant differences （χ2 =4.09, P 〈0.05）.Conclusion Standard large trauma craniectomy combined withICP can reduced pressure for the treatment of STBI and improve the prognosis.