不同手术方法治疗重型对冲性颅脑损伤的临床效果比较研究

Clinical effect of different surgical methods in the treatment of severe traumatic brain injury

目的比较双侧去骨瓣减压开颅术与单侧外伤大骨瓣减压窗术治疗重型对冲性颅脑损伤的临床效果。方法选取攀枝花市仁和区人民医院2013年10月—2015年10月收治的重型对冲性颅脑损伤患者84例,按照随机分配原则分为对照组和研究组,各42例。对照组患者采取单侧外伤大骨瓣减压术治疗,研究组患者采取双侧去骨瓣减压开颅术治疗。比较两组患者的临床效果,术后1、3、7 d颅内压情况及术后并发症发生情况。结果研究组患者临床效果优于对照组(P<0.05)。术后1 d,两组患者颅内压比较,差异无统计学意义(P>0.05);术后3、7 d,研究组患者颅内压低于对照组(P<0.05)。研究组患者切口疝、急性脑膨出发生率低于对照组(P<0.05)。结论双侧去骨瓣减压开颅术治疗重型对冲性颅脑损伤临床效果优于单侧外伤大骨瓣减压窗术,可有效降低并控制颅内压,减少不良事件发生,改善患者预后。

Objective To compare the clinical effect of bilateral decompressive craniectomy and decompression of unilateral large trauma craniotomy in the treatment of severe traumatic brain injury. Methods A total of 84 cases of patients with severe traumatic brain injury were selected from October 2013 to October 2015 in Renhe District People＇s Hospital of Panzhihua City, which were divided into control group and study group according to the principle of random assignment, 42 cases in each group. Control group was treated with decompression of unilateral large trauma craniotomy, study group was treated with bilateral deeompressive craniectomy. The clinical effect, intracranial pressure after operation of 1, 3, 7 d and the complications were compared between the two groups. Results The study group of clinical effect was better than control group （ P 〈 0. 05 ）. After operation of 1 d, no statistically significant difference of intracranial pressure was found between the two groups （ P 〉 0. 05 ） ; after operation of 3, 7 d, the intracranial pressure of study group were lower than control group （ P 〈 0. 05 ）. The study group of incisional hernia rate and acute encephalocele rate were lower than control group （ P 〈 0. 05 ）. Conclusion Bilateral decompressive craniectomy has a better effect than decompression of unilateral large trauma craniotomy in the treatment of severe traumatic brain injury, can effectively lower and control intracranial pressure, and reduce the incidence of adverse events, improve the prognosis of patients.