小硬膜窗血肿清除术与去骨瓣减压术治疗重型颅脑损伤的效果比较

Comparative Study for Application Effect on Severe Craniocerebral Injury Between Little Epidural-window Evacuation of Hematoma and Decompressive Craniectomy

目的比较小硬膜窗血肿清除术与去骨瓣减压术治疗重型颅脑损伤的效果。方法选取2013年5月—2015年6月于阳信县人民医院神经外科接受手术治疗的重型颅脑损伤患者127例,按照治疗方法分为对照组67例与观察组60例。对照组患者予以去骨瓣减压术,观察组患者予以小硬膜窗血肿清除术。比较两组患者手术时间,24 h红细胞悬液输注量,迟发性血肿、脑梗死、癫痫、术中脑膨出发生情况,术前及术后1、3、5、7 d格拉斯哥昏迷量表(GCS)评分,术前及术后24、72 h颅内压,患者预后。结果两组患者手术时间比较,差异无统计学意义(P>0.05);观察组患者24 h红细胞悬液输注量少于对照组(P<0.05)。观察组患者迟发性血肿、癫痫发生率低于对照组(P<0.05);两组患者脑梗死、术中脑膨出发生率比较,差异无统计学意义(P>0.05)。术前及术后1、3、5、7 d两组患者GCS评分比较,差异无统计学意义(P>0.05)。术前两组患者颅内压比较,差异无统计学意义(P>0.05);术后24、72 h观察组患者颅内压低于对照组(P<0.05)。观察组患者预后优于对照组(P<0.05)。结论与去骨瓣减压术比较,小硬膜窗血肿清除术可更有效地降低重型颅脑损伤患者颅内压,减少迟发性血肿及癫痫的发生,更好地改善患者预后。

Objective To compare the application effect on severe craniocerebral injury between little epidural -window evacuation of hematoma and decompressive craniectomy. Methods From May 2013 to June 2015 in the Department of Neurosurgery,the People＇s Hospital of Yangxin County,a total of 127 patients with severe craniocerebral injury were selected, and they were divided into control group（n = 67）and observation group（n = 60）according to therapeutic methods. Patients of control group received decompressive craniectomy,while patients of observation group received little epidural - window evacuation of hematoma. Duration of operation,24 - hour infusion volume of red cell suspension,incidence of delayed hematoma,cerebral infarction,epilepsy and intraoperative encephalocele,GCS score before operation and after 1 day,3 days,5 days,7 days of operation,intracranial pressure before operation and after 24 hours,72 hours of operation,and prognosis were compared between the two groups. Results No statistically significant differences of duration of operation was found between the two groups （P ﹥ 0. 05）,while 24 - hour infusion volume of red cell suspension of observation group was statistically significantly less than＆nbsp;that of control group（ P ﹤ 0. 05 ）. The incidence of delayed hematoma and epilepsy of observation group was statistically significantly lower than that of control group,respectively（P ﹤ 0. 05）,while no statistically significant differences of incidence of cerebral infarction or intraoperative encephalocele was found between the two groups（P ﹥ 0. 05）. No statistically significant differences of GCS score was found between the two groups before operation or after 1 day,3 days,5 days,7 days of operation （P ﹥ 0. 05）. No statistically significant differences of intracranial pressure was found between the two groups before operation（P﹥ 0. 05）,while intracranial pressure of observation group was statistically significantly lower than that of control group after 24 hours,72 hours of operation,respectively（P ﹤ 0. 05）. The prognosis of observation group was statistically significantly better than that of control group（ P ﹤ 0. 05）. Conclusion Compared with decompressive craniectomy,little epidural - window evacuation of hematoma can more effectively reduce the intracranial pressure,the incidence of delayed hematoma and epilepsy of patients with severe craniocerebral injury,is helpful to improve the prognosis.