损伤控制神经外科理念在双侧额叶脑挫裂伤患者救治中的应用

Damage control neurosurgery in treatment of patients with bilateral frontal contusion

目的探讨损伤控制神经外科(DCNS)理念在双侧额叶脑挫裂伤患者救治中的应用效果。方法暨南大学附属第一医院神经外科自2017年9月至2019年1月应用DCNS理念治疗双侧额叶脑挫裂伤患者33例,根据DCNS原则,严密监测病情变化,给予调整创伤后机体内环境紊乱、提高血浆渗透压、维持血氧饱和度等保守治疗,必要时行开颅减压术治疗。伤后6个月采用格拉斯哥预后量表(GOS)评分判断患者的预后。结果33例患者中,25例(76%)患者行保守治疗,8例(24%)患者保守治疗中转手术治疗。8例手术治疗患者中行单侧开颅手术5例,行双侧开颅手术3例。患者GCS评分越低,保守治疗者所占比例越低。伤后6个月GOS评分显示患者恢复良好11例,轻度残疾16例,重度残疾4例,植物生存2例。保守治疗患者中恢复良好、轻度残疾者22例,手术治疗患者中患者恢复良好、轻度残疾者5例。结论应用DCNS理念治疗双侧额叶脑挫裂伤患者,可减少开颅减压术及其并发症的发生,有利于患者康复。

Objective To investigate the therapeutic effect of damage control neurosurgery (DCNS) on patients with bilateral frontal contusion. Methods Thirty-three patients with bilateral frontal contusion, admitted to and accepted DCNS in our hospital from September 2017 to January 2019, were chosen in our study. According to DCNS rules, the disease condition changes of these patients were monitored, the internal environment disorders after trauma were adjusted, plasma osmotic pressure was increased, and blood oxygen saturation was maintained;once the patients grew worse, craniotomy and decompression should be undertaken immediately;the patients were followed up for 6 months after the injury and Glasgow outcome scale (GOS) was used to determine the prognoses of these patients. Results Among the 33 patients, 25 (76%) received conservative treatment successfully, 8 (24%) were converted to surgery during conservative treatment. Among the 8 patients, 5 received unilateral craniotomy and three received bilateral craniotomy. The lower the Glasgow coma scale scores, the lower the proportion of conservative patients. GOS 6 months after injury showed good recovery in 11 patients, mild disability in 16 patients, severe disability in 4 patients, and plant survival in two patients;22 patients from the conservative treatment group and 5 from the surgery group had good recovery or mild disability. Conclusion DCNS can reduce the operation rate and its complications so as to make the patients recover earlier and better in the treatment of bilateral frontal contusion.