标准大骨瓣减压术和常规骨瓣开颅术在重症颅脑损伤患者中的应用效果及对患者神经功能的影响

Efficacy of standard large trauma craniotomy and routine craniotomy in patients with severe craniocerebral injury and influence on neurological function

目的探讨标准大骨瓣减压术和常规骨瓣开颅术在重症颅脑损伤(TBI)患者中的应用效果及对患者神经功能的影响。方法选择我院2015年1月~2016年6月收治的60例重症TBI患者,按照随机数字表法分为观察组和对照组,各30例。对照组给予常规骨瓣开颅术治疗,观察组给予标准大骨瓣减压手术治疗。比较两组治疗效果。结果观察组预后良好率(50.0%)明显高于对照组(30.0%),差异有统计学意义(P<0.05);术前两组神经功能评分差异不显著,术后均较术前明显下降,与术前比较,差异有统计学意义(P<0.05);术后1、2个月时,观察组神经功能评分分别为(19.6±2.3)分、(11.6±1.2)分,均低于对照组的(29.7±2.9)分、(19.7±1.9)分,差异有统计学意义(P<0.05);观察组并发症发生率为6.67%明显低于对照组的23.33%,差异有统计学意义(P<0.05)。结论标准大骨瓣减压术治疗重型TBI可降低并发症,提高治疗效果。

Objective To efficacy of standard large trauma craniotomy and routine craniotomy in patients with severe craniocerebral injury and influence on neurological function.Methods 60 cases of severe TBI patients admitted to our hospital from January 2015 to June 2016 were selected and divided into observation group and control group according to random number table,each with a total of 30 cases.The control group was treated with conventional craniotomy,while the observation group was treated with standard large decompressivecraniectomy.The therapeutic effects of the two groups were compared.Results The rate of favorable prognosis in the observation group （50.0%） was higher than that in the control group （30.0%）,the difference was significant （P〈0.05）;the two groups preoperative neurological function score no significant difference after operation were significantly decreased,compared with the preoperative,the difference was statistically significant （P〈0.05）;after 1 month and 2 months,the neurological function score in observation group[（19.6±2.3）, （11.6±1.2） scores] were significantly lower than those in the control group[（29.7±2.9）,（19.7±1.9） scores],comparison between groups,the difference was statistically significant （P〈0.05）;The complication rate of the observation group was 6.67%,which was significantly lower than that of the control group （23.33%）,the difference was statistically significant （P〈0.05）.Conclusion The standard large bone flap decompression for the treatment of severe TBI has a more significant effect,not only can reduce intracranial pressure,but also can improve the neurological function,reduce the incidence of complications,to protect the safety of the operation.