大骨瓣减压术后颅脑外伤患者不同时期脑切口疝发生情况研究

Research of brain incision hernia at different periods in craniocerebral trauma patients after large trauma craniotomy

目的研究颅脑外伤患者行大骨瓣减压术后不同时期脑切口疝发生情况。方法分析76例颅脑外伤后行大骨瓣减压术患者的临床资料,观察术后前期（术后7d以内）、中期（术后7～30d）、后期（术后1～6个月）脑膨出发生率及程度,比较不同时期脑切口疝患者GCS、GOS评分。结果脑切口疝发生率85.5%,前期、中期和后期脑切口疝发生率分别为40.8%、28.9%、15.8%,三者间差异均有统计学意义（P〈0.05）。前期脑膨出程度（1.91±0.23）显著高于中（1.07±0.18）、后（1.14±0.16）期。非脑切口疝患者及前、中、后期脑切口疝患者GCS评分分别为3.19±0.31、3.46±0.52、7.12±0.44、13.24±0.47,前、中、后期三者间GCS评分差异有统计学意义（P〈0.05）,中、后期发生脑切口疝患者GCS评分显著高于无切口疝患者。非脑切口疝患者及前、中、后期脑切口疝患者GOS评分分别为4.49±0.43、4.56±0.12、3.15±0.14、1.64±0.21,前、中、后期三者间GOS评分差异有统计学意义（P〈0.05）;中、后期发生脑切口疝患者GOS评分显著低于无切口疝患者。结论颅脑外损伤患者行大骨瓣减压术后1周内脑切口疝最易发生,且程度最严重;颅脑外伤患者术前GCS评分越低,切口疝发生越早;切口疝发生越迟,患者预后越差。

Objective To study brain incision hernia at different periods in craniocerebral trauma patients after large trauma craniotomy. Methods Seventy-six cases of craniocerebral trauma patients after large trauma craniotomy were ana- lyzed. The incidences and levels of incision hernia at different periods of early, mid, later were observed. The scores of GCS,GOS at different periods were compared. Results The total incidence rate of incision hernia was 85.5%,which of early,mid, later group was 40.8%, 28.9%, 15.8%, respectively. There were significant differences among the three periods. GCS scores of non-incision-hernia, early, mid, later group were 3.19 ±0.31,3.46 ± 0.52,7.12± 0. 44,13.24 ±0.47, respectively. There were significant differences among three periods. The GCS scores of mid,later group were significantly higher than that of non- incision-hernia group. The GOS scores of non-incision-hernia, early, mid, later groups were 34.49 ± 0.43,4.56 ±0.12,3.15 ± 0.14,1.64±0.21, respectively. There were significant differences among three periods. The GOS scores of mid, later group were significantly lower than that of non-incision-hernia group. Conclusion Brain incision hernia in craniocerebral trauma pa- tients is most likely to occur in a week after operation. The lower GCS scores,the early incision hernia occurs the later incision hernia occurs,the worse of the patient prognosis.