单侧开颅联合脑室型颅内压监测治疗双侧额叶损伤的临床应用

Clinical application of unilateral craniotomy combined with intraventricular intracranial pressure monitoring in bilateral frontal lobe injury

目的探讨单侧开颅联合颅内压监护治疗双侧额叶损伤的临床应用及疗效。方法将84例双侧额叶损伤患者按半随机原则分为采用改良手术方式治疗组(治疗组)和常规冠状切口双额部开颅手术组(对照组);每组各42例患者。术后30 d给患者行简易精神状态检查(mini-mental state examination,MMSE)量表评分;术后3个月给患者行格拉斯哥预后量表(Glasgow outcome scale,GOS)评分,GOS评分4~5分者为预后良好,1~3分者为预后不良。结果术后30 d治疗组患者的MMSE量表评分明显高于对照组,差异有统计学意义(P<0.05)。术后3个月时两组的预后良好率及重残、植物生存率的差异均无统计学意义(均P>0.05)。结论单侧开颅联合脑室型颅内压监测治疗双侧额叶损伤,能减轻患者的认知功能损害,改善预后;并且符合目前精准化治疗原则。

Objective To investigate the therapeutic effect of unilateral craniotomy combined with intracranial pressure monitoring in bifrontal contusion.To explore the clinical application and efficacy of unilateral craniotomy combined with intracranial pressure monitoring in the treatment of bilateral frontal lobe injury.Methods A total of 84 cases of bifrontal contusion are divided into two groups randomly and analyzed prospectively.According to the semi-random principle,84 patients with bilateral frontal lobe injury were divided into modified operation group and conventional coronal incision frontal bilateral craniotomy group.The patients were evaluated with mini mental state examination(MMSE)30 days after operation and Glasgow outcome scale(GOS)3 months after operation.The prognosis was good in patients with GOS score of 4 to 5 and poor prognosis in patients with GOS score of 1 to 3.Results On the 30th day after operation,the score of MMSE scale in the modified operation group was significantly higher than that in the control group(P<0.05).There was no significant difference in the rate of good prognosis,severe disability and vegetative survival rate between the two groups at 3 months after operation(P>0.05).Conclusion Unilateral craniotomy combined with intraventricular intracranial pressure monitoring can reduce the cognitive impairment of patients and improve the prognosis,and in line with the current principle of accurate treatment.