控制性减压术与标准大骨瓣减压术防治老年重型颅脑损伤并发脑梗死的对照研究

Comparative study on controlled decompression and standard decompressive craniectomy in treating severe craniocerebral injury and in preventing cerebral infarction in the elderly

目的比较控制性减压术与标准大骨瓣减压术在防治老年重型颅脑损伤并发脑梗死中的应用价值。方法选取我院2012年1月至2015年8月收治的92例老年重型颅脑损伤病人作为研究对象,按照随机数字表将其分成2组,每组46例。观察组行控制性减压术治疗,对照组行标准大骨瓣减压术治疗,比较2组病人术中、术毕、术后6月颅内压控制情况,术后脑梗死发生情况以及术后6月预后情况。结果观察组术中、术毕、术后6月各时点颅内压均显著低于对照组(P<0.01);观察组脑梗死发生率为6.52%,明显低于对照组(23.91%),平均脑梗死体积为(6.11±1.36)cm3,明显小于对照组(P<0.05);观察组病人术后6月神经行为认知状态检查表评分、Barthel指数、GOS评分均显著高于对照组(P<0.01);观察组预后良好率为78.26%,相对于对照组的39.13%有明显上升(P<0.01)。结论控制性减压术治疗老年重型颅脑损伤效果显著,可有效降低术后脑梗死发生率,改善病人预后。

Objective To compare the application value of controlled decompression and standard decompressive craniectomy on the prevention of severe craniocerebral injury complicated with cerebral infarction in the elderly. Methods Ninety-two patients with severe craniocerebral injury recruited in our hospital were divided into two groups randomly,with 46 cases in each group. Patients in observation group received controlled decompression treatment, and the control group underwent standard decompressive craniectomy treatment. Intracranial pressure,the incidence rate of cerebral infarction and the prognosis of the two groups were recorded and compared. Results Intracranial pressure in observation group was significantly lower than that in the control group during operation,at the end of operation and six months after operation（ P〈0. 01）. The incidence rate of cerebral infarction in the observation group was 6. 52%,which was significantly lower than that of the control group（ 23. 91%）. The mean infarct volume was 6. 11±1. 36 cm3 and 12. 09±3. 64 cm3 in the observation group and control group respectively,with significant difference（ P〈0. 05）. NCSE, Barthel index and GOS scores of the observation group six months after operation were significantly higher than those of control group（ P〈0. 01）. And the patients in the observation group showed better prognosis compared to the control group（ P〈0. 05）. Conclusions Controlled decompression treatment in elderly patients with severe brain injury can effectively reduce the incidence of postoperative cerebral infarction and improve prognosis.