重型颅脑损伤采用大骨瓣减压术治疗的观察

Observation of large decompressive craniectomy applied in the treatment of severe craniocerebral injury

目的探讨重型颅脑损伤应用大骨瓣减压术治疗的疗效,为临床治疗提供参考依据。方法 100例重型颅脑损伤患者,随机分成对照组和研究组,各50例。对照组采取常规骨瓣减压术治疗,研究组采用大骨瓣减压术治疗。比较两组的临床疗效。结果治疗前对照组患者平均格拉斯哥昏迷评分(GCS)(6.39±0.27)分,治疗后平均GCS评分(10.57±0.33)分;治疗前研究组患者平均GCS评分(6.40±0.29)分,治疗后平均GCS评分(13.04±0.35)分。治疗前两组患者平均GCS评分比较差异无统计学意义(P>0.05),治疗后两组患者平均GCS评分比较差异具有统计学意义(P<0.05)。治疗后对照组患者格拉斯哥预后评分(GOS)分级:5级6例,4级7例,3级17例,2级8例,1级12例。治疗后研究组患者GOS评分分级:5级15例,4级17例,3级9例,2级4例,1级5例。治疗后两组患者GOS评分分级比较差异具有统计学意义(P<0.05)。结论相比较常规的治疗方法 ,使用大骨瓣减压术治疗重型颅脑损伤患者临床效果更好,能够降低患者死残率,值得在临床上进一步推广和使用。

Objective To investigate curative effect by large decompressive craniectomy applied in the treatment of severe eraniocerebral injury, and to provide reference frame for clinical treatment. Methods A total of 100 patients with severe cranioeerebral injury were randomly divided into control group and research group, with 50 cases in each group. The control group received conventional decompressive craniectomy for treatment, and the research group received large decompressive craniectomy instead. Clinical effects were compared between the two groups. Results The control group had mean Glasgow coma scale （GCS） score as （6.39 ± 0.27） points before treatment and （10.57 ± 0.33） points after treatment. The research group had mean GCS as （6.40 ± 0.29） points before treatment and （13.04 ± 0.35） points after treatment. There was no statistically significant difference of mean GCS score before treatment between the two groups （P〉0.05）, while the difference after treatment had statistical significance between the two groups （P〈0.05）. The control group had 6 cases of grade 5 in Glasgow outcome score （GOS） after treatment, 7 cases of grade 4, 17 cases of grade 3, 8 cases of grade 2 and 12 cases of grade 1. The research group had 15 cases of grade 5 in GOS after treatment, 17 cases of grade 4, 9 cases of grade 3, 4 cases of grade 2 and 5 cases of grade 1. The difference of GOS after treatment had statistical significance between the two groups （P〈0.05）. Conclusion Comparing with conventional treatment method, large decompressive craniectomy provides better clinical effect in treating severe cranioeerebral injury. This method can reduce mortality rate and disability rate in patients, and it is worth further clinical promotion and application.