颅脑外伤去骨瓣减压术后早期行颅骨修补术的临床价值研究

Clinical Value of Early Cranioplasty after Craniocerebral Trauma with Decompressive Craniectomy

目的:探究颅脑外伤去骨瓣减压术后早期行颅骨修补术对患者预后的影响。方法:选取2015年1月至2017年2月在我院行颅脑外伤去骨瓣减压术患者90例作为研究对象,按随机数字表法分为两组,即观察组和对照组,每组各45例。对照组术后> 6个月行颅骨修补术,观察组术后≤3个月行颅骨修补术,随访6个月,比较两组脑灌注水平、生活质量、认知功能、神经功能和预后情况。结果:两组患者术后10 d达峰值时间(TTP)均较术前低,局部脑血流量(rC BF)较术前高,且观察组优于对照组,差异有统计学意义(P <0. 05);两组患者术后6个月生活质量表(QOL)、简明精神状态量表(MMSE)、卡氏功能状态(KPS)、格拉斯哥预后分级(GOS)评分均较术前高,美国国立卫生研究院卒中量表(NIHSS)评分较术前低,且观察组优于对照组,差异有统计学意义(P <0. 05);观察组并发症发生率较对照组低,差异有统计学意义(P <0. 05)。结论:颅脑外伤去骨瓣减压术后早期行颅骨修补术可加快血流速度,增加脑血流量,改善患者认知功能、生活质量和神经功能,减少并发症发生,利于患者预后。

Objective： To investigate the effect of early cranioplasty after craniocerebral trauma with decompressive craniectomy on the prognosis. Methods ： 90 cases of craniocerebral trauma with decompressive cranieetomy in the hospital from January 2015 to February 2017 were selected, and randomly divided into two groups, the observation group and the control group, with 45 cases in each group. The control group was given cranioplasty 〉6 months after surgery, while the observation group was given cranioplasty ≤3 months after surgery. After 6- month follow-up, the cerebral peffusion level, living quality, cognitive function, nerve function and prognosis were compared between the two groups. Results： 10 d after surgery, the TTP of two groups were lower than those before surgery, rCBF was higher than that before surgery, and the observation group was better than the control group （P 〈0. 05）. 6 months after surgery, the scores of QOL, MMSE, KPS, COS in the two groups were higher than those before surgery, the NIHSS score was lower than that before surgery, and the observation group was better than the control group （ P 〈 0. 05 ）. The incidence of complications in the observation group was lower than that in the control group （P 〈 0. 05）. Conclusion ： Early cranioplasty after craniocerebral trauma with decompressive craniectomy can accelerate blood flow velocity, increase cerebral blood flow, improve cognitive function, living quality and nerve function, reduce complications and promote prognosis.