双额大骨瓣减压术治疗外伤后难治性弥漫性脑肿胀的研究

Role of bifrontal decompressive craniectomy in the management of refractory brain swelling after head injuries

目的探讨双额大骨瓣减压术对脑外伤后难治性弥漫性脑肿胀的治疗效果。方法将重型颅脑损伤后难治性脑肿胀患者80例随机分为2组,观察组40例采用双额大骨瓣减压术治疗,对照组40例采用保守治疗。出院后随访6个月,应用格拉斯预后评分(GOS)评价2组治疗效果,并统计2组并发症发生情况。结果观察组入院时颅内压为(36.0±7.1)mm Hg(1 mm Hg=0.133 k Pa),从入院到手术结束时间为4~16(11.1±4.8)h,术后颅内压明显下降至(16.7±4.8)mm Hg(P<0.05)。对照组入院时颅内压为(34.2±6.2)mm Hg,入院后11.1 h颅内压为(32.7±4.8)mm Hg(P>0.05);2组术后颅内压比较差异有统计学意义(P<0.05)。观察组入院24 h后环池受压好转率显著高于对照组(P<0.05)。观察组术后出现硬膜下积液1例,脑积水1例,对照组未见明显不良反应发生。出院后6个月随访观察组预后显著优于对照组(P<0.05)。结论双额大骨瓣减压术是一种快速有效的降低外伤后难治性弥漫性脑肿胀患者颅内压的手术方法,可改善环池受压,且并发症较少,能明显改善患者的预后。

Objective It is to analyze the effects of bifrontal decompressive craniectomy on refractory brain swelling af- ter traumatic brain injuries. Methods 80 patients with refractory brain swelling after severe head injuries were randomly di- vided into 2 groups： the observation group （n = 40） treated with bifrontal decompressive craniectomy and the control group （n = 40） treated with non-operative therapy. The Glasgow Outcome Scale（GOS） at the 6-months following-up was com- pared to evaluate treatment effectiveness and complications in both groups. Results The intracranial pressure （ICP） at ad- mission was （36.0± 7. 1 ） mmHg, which significantly fell to （ 16.7 ± 4.8） mmHg after the operation in the observation group （P 〈 0.05 ）. The time from administration to the end of operation was 4 -16 （11.1 ± 4.8 ）h. In the control group, ICP fell from （34.2 ±6.2）mmHg to （32.7 ±4.8） mmHg after 11.1 hours since admission. The difference in ICP between the observation group and the control group had statistical significance （P 〈 0.05）. The ambient cistern compression improve- ment rate was significantly higher in the observation group than that in the control group in 24 hours after admission （P 〈 0. 05）. One patient had postoperative subdural effusion and one patient had postoperative hydrocephalus in the observation group. There was no obvious side effect in the control group. The results of following up in 6months after discharge showed that the prognosis of the observation group was better than that of the control group （P 〈 0. 05）. Conclusion Bifrontal de- compressive craniectomy was a suitable measure to decrease the ICP in the patients with refractory brain swelling and amel- iorate ambient cistern compression to reduce complications which could provide better outcome for these patients.