急性脑膨出预防模式在幕上重型颅脑外伤治疗中的应用及脑膨出危险因素分析

Application of acute encephalocele prevention model in supratentorial severe craniocerebral trauma and analysis of risk factors for encephalocele

目的探讨急性脑膨出预防模式在幕上重型颅脑外伤(sTBI)大骨瓣减压术中的应用及脑膨出危险因素。方法选取郴州市第一人民医院神经外科自2016年5月至2018年5月收治的行大骨瓣减压术治疗幕上sTBI的患者130例,根据随机数字表法分成对照组(65例)、观察组(65例)。对照组仅进行常规术前准备,观察组采用急性脑膨出预防模式。比较2组患者急性脑膨出发生率,术后随访6个月,利用GOS评分评价患者的预后。采用单因素与Logistic多因素分析急性脑膨出的危险因素。结果观察组急性脑膨出发生率(9.23%)低于对照组(23.08%),差异有统计学意义(P<0.05)。观察组预后良好率(75.38%)显著高于对照组(56.92%),差异有统计学意义(P<0.05)。Logistic回归模型提示GCS评分(3~5分)、无急性脑膨出预防模式、迟发型出血、弥漫性脑肿胀、脑挫伤是急性脑膨出的危险因素(P<0.05)。采用急性脑膨出预防模式是预防急性脑膨出的保护性因素(P<0.05)。结论急性脑膨出预防模式的应用能降低幕上sTBI患者急性脑膨出发生率,可提高预后良好率,且急性脑膨出的发生与GCS评分(3~5分)、无急性脑膨出预防模式、迟发型出血、弥漫性脑肿胀、脑挫伤有关。

Objective To explore the application of acute encephalocele prevention model in large bone flap decompression for severe supratentorial craniocerebral trauma (sTBI) and the risk factors of encephalocele. Methods One hundred and thirty patients of supratentorial sTBI treated with large bone flap decompression from May 2016 to May 2018 in the Department of Neurosurgery of Chenzhou First People’s Hospital were selected. The patients were divided into control group (n=65) and observation group (n=65). The control group only received routine preoperative preparation, while the observation group adopted the prevention model of acute encephalocele. The incidence of acute encephalocele was compared between the two groups. The patients were followed up for 6 months. The GOS was used to evaluate the prognosis of patients. Risk factors of acute encephalocele were analyzed by univariate and logistic multivariate analysis. Results The incidence of acute encephalocele in the observation group was 9.23%, which was lower than that in the control group 23.08%(P<0.05). The good prognosis rate was 75.38% in the observation group, which was significantly higher than 56.92% in the control group (P<0.05). Logistic regression model suggested that GCS score (3-5 points), no acute encephalocele prevention model, delayed hemorrhage, diffuse brain swelling and brain contusion were risk factors for acute encephalocele (P<0.05). Acute encephalocele prevention model is a protective factor for the prevention of acute encephalocele (P<0.05). Conclusion The application of prevention model of acute encephalocele can reduce the incidence of acute encephalocele in supratentorial sTBI patients and improve the prognosis. The occurrence of acute encephalocele was related to GCS score (3-5 points), no prevention mode of acute encephalocele, delayed hemorrhage, diffuse brain swelling and brain contusion.