逐步控制性减压在急性硬膜下血肿合并脑挫伤患者中的应用

The experience of gradually controlled decompression for acute subdural hematoma combined with brain contusion patients

目的:探讨逐步控制性减压在急性硬膜下血肿(acute subdural hematoma,ASDH)合并脑挫伤患者手术中的临床疗效。方法:365例ASDH合并脑挫伤需行减压手术的患者中,观察组195例采用逐步控制性减压手术,对照组170例采用常规标准大骨瓣快速减压手术。比较两组患者的术后3个月的格拉斯哥预后评分(GOS),以及术中和术后并发症发生情况。结果:两组患者术中急性脑膨出、迟发颅内血肿、脑干移位、大面积脑梗塞、术中低血压及术后高颅压的发生率以及患者预后情况差异均有统计学意义(P<0.05)。结论:采用逐步控制性减压手术能有效减少ASDH合并脑挫伤患者术中及术后并发症,降低伤残率及死亡率,是一种有效的手术方法。

Objective： To investigate the clinical effect of gradually controlled decompression in the treatment of acute subdural hematoma complicated with brain contusion. Methods.. Among the 365 ASDH patients complicated with cerebral contusion who require decompression surgery, 195 cases of the observation group underwent progressive decompression operation, and 170 cases of the control group underwent conventional standard large bone flap decompression operation. The Glasgow Outcome Scale （GOS） scores three months after the operation were compared between the two groups, and intraoperative and postoperative complications were observed. Results： Acute intraoperative encephalocele, delayed intracranial hematoma, brain stem displacement, massive cerebral infarction, postoperative intraeranial hypertension and intraoperative hypotension, and the prognosis of two groups were compared, and the differences were all statistically significant （P〈0. 05）. Conclusions： The gradually controlled decompression surgery can effectively reduce intraoperative and postoperative complications, disability and mortality in ASDH patients complicated with cerebral contusion, so it is an effective surgical method.