手术治疗重型颅脑损伤58例临床疗效分析

Clinical effect of 58 patients with severe craniocerebral injury treated by surgery

目的：探讨标准大骨瓣减压术治疗重型颅脑损伤患者的临床疗效。方法选择重型颅脑损伤患者58例，按照手术方法不同，将其分为对照组和研究组，每组各29例，对照组采用常规的骨瓣开颅手术，研究组采用去大骨瓣减压手术。术后比较两组临床效果及并发症发生情况。结果术后随访5个月，研究组死亡率（10．34％）明显低于对照组（27．59％），且差异有统计学意义（χ2＝3．98，P ＜0．05）；研究组良好率（55.17％）明显高于对照组（27．59％），且差异有统计学意义（χ2＝4．55，P ＜0．05）。两组术前颅内压差异无统计学意义（P ＞0．05）；而术后1 d、3 d 及5 d 研究组颅内压明显低于对照组，且差异有统计学意义（t ＝3．55、4．02、6．12，均 P ＜0．05）。研究组 GOS 和 BAI 评分均较对照组明显升高，且差异有统计学意义（t ＝5．02、4.21，P ＜0．05）。研究组脑脊液漏、外伤性脑梗死、外伤性癫痫、脑积水、伤口感染等并发症发生率均明显低于对照组，且差异有统计学意义（χ2＝4．00、5．02、4．56、4．22、3．99，均 P ＜0．05）。结论标准大骨瓣减压术较常规骨瓣开颅术视野开阔，大大降低了病死率，降颅压更显著，改善和提高了患者的生存质量，对重型颅脑损伤的疗效及预后更优，值得临床应用。

Objective To investigate the clinical effect of standard large bone flap decompression for severe craniocerebral injury.Methods This study was performed in 58 patients with severe traumatic brain injury,according to different surgical methods,the patients were divided into control group and study group,29 cases in each group.The control group was treated with conventional bone flap craniotomy,and the study group was treated with large bone flap decompression surgery.The clinical effect and complications were compared between the two groups.Results After operation,the patients were followed up for 5 months.The mortality of the study group （10.34%）was significantly lower than that of the control group （27.59%）,and the difference was statistically significant （χ2 =3.98,P ＆lt;0.05）.In addition,the good rate of the study group （55.17%）was significantly higher than that of the control group （27.59%）,and the difference was significant （χ2 =4.55,P ＆lt;0.05）.The preoperative intracranial pressure had no significant difference between the two groups.While at postoperative 1d,3d and 5d,the intracranial pressure of the study group was significantly lower than that of the control group,and the difference was statistically significant （t =3.55,4.02,6.12,all P ＆lt;0.05）.The scores of GOS and BAI in the study group were significantly higher than those in the control group （t =5.02,4.21,P ＆lt;0.05 ）.The incidence rates of complications such as cerebrospinal fluid leakage,trauma of cerebral infarction,trauma of epilepsy,hydrocephalus,wound infection of the study group were sig-nificantly lower than those of the control group,and the differences were statistically significant （χ2 =4.00,5.02, 456,4.22,3.99,all P ＆lt;0.05）.Conclusion Compared with conventional craniotomy,open standard big bone flap decompression can significantly reduce the mortality rate,decrease intracranial pressure,and improve the quality of life of patients,it has better curative effect and prognosis for patients with severe craniocerebral injury,and is worthy of clinical application.