早期脑室-腹腔分流术同期联合颅骨修补术对脑外伤伴脑积水的作用评价

Evaluation of early ventricular-peritoneal shunt combined with cranioplasty on traumatic brain injury with hydrocephalus

目的通过对本院脑外伤伴随脑积水患者进行对照试验,探讨传统手术与早期脑室-腹腔分流术联合颅骨修补术在脑外伤伴随脑积水治疗中的疗效。方法选择本院2017年1月至2019年1月收治的脑外伤伴脑积水患者60例作为研究对象,根据不同的手术方式分为观察组与对照组,各30例。观察组患者采用同期手术进行治疗,即同期施行早期脑室-腹腔分流术与颅骨修补术,对照组患者采用分期手术进行治疗,即先实施早期脑室-腹腔分流术,术后3个月再施行颅骨修补术。比较两组患者术前、术后颅内压水平、生活自理能力(MBI)、生活质量(QOL)评分、术后并发症。结果与对照组对比,观察组术后颅内压水平明显更低(P<0.05)。与术前对比,两组患者术后颅内压水平明显降低(P<0.05)。两组治疗后MBI评分均高于治疗前(P<0.05);与对照组对比,观察组治疗后MBI评分明显更高(P<0.05)。两组治疗后QOL评分均高于治疗前(P<0.05);与对照组对比,观察组治疗后QOL评分明显更高(P<0.05)。与对照组对比,观察组硬膜下积液、再出血、感染的并发症率明显更低(P<0.05)。两组脑功能衰竭、多器官功能衰竭并发症率比较差异无统计学意义。结论与传统手术对比,早期脑室-腹腔分流术联合颅骨修补术在脑外伤伴随脑积水治疗中的疗效更加安全确切。

Objective To investigate the efficacy of traditional surgery and early ventricular-peritoneal shunt combined with cranioplasty in the treatment of cerebral trauma with hydrocephalus in a controlled trial in our hospital. Methods 60 patients with traumatic brain injury and hydrocephalus from January 2017 to January 2019 were selected as the research objects, and they were divided into observation group and control group according to different surgical methods, with 30 cases in each group. Patients in the observation group were treated with contemporaneous surgery, that is,early ventricle-peritoneal shunt surgery and skull repair were performed concurrently. Patients in the control group were treated with staged surgery,that is, early ventricular-peritoneal shunt surgery was performed first, and skull was performed 3 months after surgery. Repair. The intracranial pressure levels, MBI, QOL scores, and postoperative complications were compared between the two groups. Results Compared with the control group,the intracranial pressure level in the observation group was significantly lower(P<0.05). Compared with preoperative, the intracranial pressure level in the two groups was significantly reduced(P<0.05). The MBI scores after treatment in both groups were higher than before treatment(P<0.05).Compared with the control group, the MBI scores in the observation group were significantly higher after treatment(P<0.05). The QOL scores after treatment in both groups were higher than before treatment(P<0.05). Compared with the control group, the QOL scores in the observation group were significantly higher after treatment(P<0.05). Compared with the control group, the complications of subdural effusion, rebleeding and infection were significantly lower in the observation group(P<0.05). There was no significant difference in the complication rates of brain failure and multiple organ failure between the two groups. Conclusion Compared with traditional surgery, early ventricular-peritoneal shunt combined with cranial repair is more effective in the treatment of traumatic brain injury with hydrocephalus.