控制性减压在重型颅脑损伤手术中的应用

Application of controlled decompression to patients with severe traumatic brain injury

目的探讨控制性减压术治疗重型颅脑损伤的临床疗效。方法 2014年1月至2017年3月共收治符合标准的颅脑损伤146例,采用控制性减压术治疗52例(观察组),标准大骨瓣减压术治疗94例(对照组)。结果观察组术后1周病死率(17.3%)与对照组(20.2%)无统计学差异(P>0.05)。观察组术中出现急性脑膨出发生率(13.5%)明显低于对照组(28.7%;P<0.05)。观察组术后迟发性颅内血肿发生率(14.3%)、脑积水发生率(11.9%)均明显低于对照组(分别为36.8%、30.3%;P<0.05)。伤后6个月按GOS评分评估疗效。观察组恢复良好27例,中残6例,重残3例,植物生存2例,死亡14例;对照组恢复良好30例,中残6例,重残15例,植物生存14例,死亡29例。观察组恢复良好率(51.9%)明显高于对照组(31.9%;P<0.05)。结论重型、颅脑损伤去骨板减压术中采用控制性减压方法有助于减少手术并发症,改善病人预后。

Objective To investigate the clinical effects of controlled decompression on severe traumatic brain injury(sTBI).Methods Of 146 patients with sTBI,52(treatment group)underwent controlled decompression and 94(control group)underwent decompression of routine standard large craniotomy.Results The rates of occurrences of intraoperative acute encephalocele,delayed intracranial hematoma and hydrocephalus were significantly lower in the treatm ent group than those in the control group(P<0.05).GOS scores were significantly higher in the treatm ent group than those in the control group 6 months after the operation(P<0.05).Conclusions The controlled decompression may decrease the rates of the rate of encephalocele,delayed intracranial hematoma,and hydrocephalus and improve the prognoses in the patients with sTBI.