双侧开颅不同手术时机与方式治疗外伤性多发性颅内血肿的效果分析

Evaluation of the effects of bilateral craniotomy with different surgical timings and modes on traumatic multiple intracranial hematoma

目的分析双侧开颅不同手术时机与方式治疗外伤性多发性颅内血肿的临床效果。方法选取2011-03~2017-06该院收治的100例外伤性多发性颅内血肿患者,采用单双号的方法分为观察组和对照组,每组50例。对照组患者采用分期双侧开颅手术治疗,观察组患者采用Ⅰ期双侧开颅手术治疗。观察两组患者临床治疗效果和格拉斯哥预后(GOS)评分情况。结果对照组治疗良好率为82.0%(16例恢复良好,25例轻度残疾,6例重度残疾,2例植物生存,1例死亡),观察组治疗良好率为96.0%(28例恢复良好,20例轻度残疾,1例重度残疾,1例植物生存),差异有统计学意义(P<0.05)。观察组临床疗效明显优于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者GOS评分[(2.15±0.64)分vs (2.18±0.59)分]差异无统计学意义(P>0.05);治疗后,对照组患者GOS评分为(3.37±0.97)分,观察组患者GOS评分为(4.52±0.83)分,观察组GOS评分明显高于对照组,差异有统计学意义(P<0.05)。结论与分期双侧开颅手术相比,外伤性多发性颅内血肿患者采用Ⅰ期双侧开颅手术临床治疗效果更佳,在临床上值得推广应用。

Objective To evaluate the effects of bilateral craniotomy with different surgical timings and modes on traumatic multiple intracranial hematoma(TMIH).Methods One hundred cases of TMIH were collected in our hospital from March 2011 to June 2017 and were divided into the observation group and the control group according to the date(odd-even day)of admisson,with 50 cases in each group.The control group received staged bilateral craniotomy treatment,and the observation group received phaseⅠbilateral craniotomy treatment.The clinical effects and GOS scores were compared between the two groups.Results In the control group,good recovery was in 16 cases,mild disability in 25 cases,severe disability in 6 cases,persistent vegetative state in 2 cases and death in 1 case.In the observation group,good recovery was in 28 cases,mild disability in 20 cases,severe disability in 1 case,and persistent vegetative state in 1 case.The excellent and good rate of the observation group(96.0%)was significantly higher than that of the control group(82.0%)(P<0.05).The clinicl effect of the observation group was better than thit of the cortrol group(P<0.05).Before treatment,there were no significant differences in GOS scores between the two groups[(2.15±0.64)points vs(2.18±0.59)points](P>0.05).After treatment,the GOS scores of the observation group[(4.52±0.83)points]were significantly higher than those of the control group[(3.37±0.97)points](P<0.05).Conclusion PhaseⅠbilateral craniotomy is more effective than staged bilateral craniotomy in the treatment of TMIH.PhaseⅠbilateral craniotomy is worth applying in clinic.