标准外伤大骨瓣减压术对外伤性多发性颅内血肿患者术后意识障碍恢复的影响

Influence of standard trauma craniectomy in conscious disturbance recovery in patients with traumatic multiple intracranial hematoma

目的:观察标准外伤大骨瓣减压术(STC)后患者意识障碍恢复情况,探讨其在外伤性多发性颅内血肿(TMIH)治疗中的价值。方法:收集2014年手术治疗的TMIH患者57例,其中行STC患者39例,行常规开颅手术18例,排除1个月内死亡、失联和占位病变等患者,分别随机选取STC组10例和对照组(常规开颅组)10例。通过重复测量方差分析以及Wilcoxon秩和检验对术前和术后24h、1周及1个月格拉斯哥昏迷量表(GCS)评分进行统计学分析。结果:综合术后时间因素及术式因素进行分析,术后不同时间点GCS评分比较差异均有统计学意义(P<0.05),随术后时间延长,GCS评分呈逐步升高趋势。不同术式间GCS评分比较差异无统计学意义(P>0.05),不同术式对GCS评分整体恢复趋势相同,但在不同时间点GCS评分因术式不同存在差异。通过Wilcoxon秩和检验分析GCS评分变化率,与对照组比较,术后24h和术后1周时STC组GCS评分变化率明显升高(P<0.01),而术后1个月时GCS评分变化率差异无统计学意义(P>0.05)。结论:与常规开颅手术比较,STC对术后7d内TMIH患者意识障碍的恢复作用明显,而对术后1个月患者意识障碍的恢复无明显改善作用。

Objective： To observe the conscious disturbance recovery in the patients with traumatic multiple intracranial hematoma （TMIH） after standard trauma craniectomy （STC）, and to explore its value in the treatment of TMIH. Methods.. The clinical data of TMIH patients with surgical treatments in 2014 were collected. The patients who dead within one month after surgery, could not be contacted or diagnosed with space-occupying lesions were excluded. According to surgical procedures, the patients were classified as STC group and control group （conventional craniotomy surgery）. For each group, 10 cases were randomly selected. Using repeated measurement of variance analysis and Wilcoxon rank sum test, the changes of Glasgow Coma Scale （GCS） scores were analyzed before operation and 24 h, 1 week, 1 month after operation. Results.. There were significant changes of GCS at different time points （P〈 0.05） by the comprehensive analysis of postoperative time factor and operation factor, which meaned that GCS showed a trend of gradual increase, along with the postoperative time prolongation. The postoperative time factor showed improvement effect on the GCS score, but there was no significant difference in GCS scores between different operation methods （P 〈 0.05）. The GCS score overall recovery trend of different operative methods was the same, but at different time points the GCS score recovery had differences between the different operative methods. By Wilcoxon rank sum test analysis, the rates of GCS score changes were significantly different in STC group and control group （P〈0.01） at the time points of 24 h and 1 week after operation. But there was no significant difference in the GCS score change between two groups 1 month after operation （P〈0.05）. Conclusion.. Compared with conventional craniotomy surgery, STC has significant effect on the recovery of conscious disturbance 7 d after operation but STC has no effect on the recovery of conscious disturbance of the patients 1 month after operation.