半球骨瓣减压术辅助亚低温治疗颅脑创伤的临床疗效

Clinical effect of hemisphere bone flap decompressive craniectomy and adjuvant mild hypothemia therapy for craniocerebral injury

目的观察半球颅骨骨瓣减压术辅助亚低温联合小剂量脱水药救治重型颅脑创伤后恶性高颅压临床效果,探讨合理用药降低颅内压最有效的方法。方法本组患者选择行"半球颅骨骨瓣减压术",术后早期行气管切开并辅"亚低温"和"联合小剂量脱水物"治疗恶性高颅压,维持肛温35℃左右,小剂量甘露醇125 m L快速静点4~6 h一次,呋塞米40~60 mg滴斗入4~6 h一次,两者交替给药,甲泼尼龙40 mg静点4~6 h一次。结果 378例患者根据GOS评分判定疗效:恢复良好252例,重残56例,植物生存18例,死亡52例。死亡率19%。结论半球颅骨骨瓣减压术辅助亚低温联合小剂量脱水药救治重型颅脑创伤后恶性高颅压明显降低了致残率、死亡率。

Objective The clinical effect of hemisphere skull bone flap decompression and adjuvant mild hypothemia in combination with small dose of dehydration medication for the malignant high cranial pressure following Craniocerebral injury was discussed, and the proper methods to reduce the intracranial pressure by rational using of drugs were studied. Methods Early reintubation after hemisphere bone flap decompression and adjuvant mild hypothemia in combination with small dose of dehydration medication were perfomred for the treatment of malignant high cranial pressure. Temperature was maintained around 35 ℃ anus. Small dose of mannitol 125 mL rapid static point was performed once per 4 -6 hours and 40 to 60 nag frusemide was dropped once per 4 -6 hours. Both two medication were given alternatively, and a nylon 40 mg static point was performed once per 4 -6 hours. Results COS was used to evaluate the clinical effect of 378 patients： good recovery in 252 cases, severely disabled in 56 patients, vegetative survival in 18 cases, and death in 52 eases. The mortality rate was 19%. Conclusion Hemisphere bone flap decompression and adjuvant mild hypothemia in combination with small dose of dehydration medication reduces effectively the morbidity and meaality of malignant high pressure after eranioeerebral injury.