预见性与相继性双侧去骨瓣减压术治疗重度颅脑损伤的临床观察

Study on the Clinical Efficacy and Safety of Predictive and Sequential Bilateral Decompressive Craniectomy in the Treatment of Severe Craniocerebral Injury

目的比较预见性和相继性双侧去骨瓣减压术治疗重度颅脑损伤患者的临床疗效和安全性。方法将2016年9月至2019年9月我院收治的80例重度颅脑损伤患者随机分为对照组(n=40)和实验组(n=40),对照组采用相继性双侧去骨瓣减压术治疗,实验组采用预见性双侧去骨瓣减压术治疗。比较两组患者手术前后颅内压变化和术后并发症发生情况,采用哥斯拉哥评分(GOS)评估患者预后效果。结果两组术后1、2、3 d的颅内压均低于术前(P<0.05),在术后1、2、3 d的颅内压上,实验组明显低于对照组,差异具有统计学意义(P<0.05);实验组的并发症总发生率为7.50%(3/40),低于对照组的25.00%(10/40)(P<0.05);对比GOS恢复良好率和死亡率,实验组明显更优,差异具有统计学意义(P<0.05)。结论相较于相继性双侧去骨瓣减压术,重度颅脑损伤患者采用预见性双侧去骨瓣减压术后颅内压得到进一步降低,减少术后并发症,预后效果良好,安全性较高。

Objective To compare the clinical efficacy and safety of predictive and sequential bilateral decompressive craniotomy for severe craniocerebral injury.Methods Eighty patients with severe craniocerebral injury who were admitted to our hospital from September 2016 to September 2019 were randomly divided into the control group(n=40)and the experimental group(n=40).The control group was treated with sequential bilateral decompressive craniotomy,while the experimental group was treated with predictive bilateral decompressive craniotomy.The changes in intracranial pressure and postoperative complications of the two groups were compared before and after surgery.Glasgow outcome scale(GOS)score was used to evaluate the prognosis of the patients.Results The intracranial pressure of the two groups on the 1st,2nd and 3rd day after surgery was lower than that before surgery(P<0.05).The intracranial pressure of the experimental group on the 1st,2nd and 3rd day after surgery was significantly lower than that of the control group,with statistically significant difference(P<0.05).The total incidence of complications in the experimental group was 7.50%(3/40),which was lower than 25.00%(10/40)in the control group(P<0.05).Compared with the good recovery rate and mortality rate of GOS,the experimental group was significantly better,and the differences were statistically significant(P<0.05).Conclusion Compared with sequential bilateral decompressive craniotomy,predictive bilateral decompressive craniotomy can further reduce intracranial pressure and postoperative complications of patients with severe craniocerebral injury,with better prognosis and higher safety.