探讨去骨瓣减压术治疗重型颅脑创伤的临床疗效

Exploring the Clinical Effect of Decompressive Craniectomy for Severe Traumatic Brain Injury

目的观察与评价去骨瓣减压术治疗重型颅脑创伤的临床疗效。方法于该院2015年3月—2019年9月收治的重型颅脑创伤患者中便利选择74例作为该次研究的对象,系统随机编号,奇数为试验组,偶数为对照组。试验组采用改良去骨瓣减压术治疗,对照组采用常规外伤大骨瓣减压术治疗。比较两组患者手术指标、手术前后颅内压水平、临床疗效以及并发症发生率。结果术后,试验组患者颅内压水平3 d(16.02±2.13)mmHg、一周(14.70±0.28)mmHg明显低于对照组(24.12±2.08)mmHg、(20.88±2.22)mmHg,试验组患者手术时间(48.62±10.82)min、术中出血量(96.05±16.11)mL、住院时间(14.70±0.28)d,少于对照组(71.62±11.67)min、(124.68±15.76)mL、(21.60±0.33)d,差异有统计学意义(t=3.989、4.248、4.076、4.208、4.124,P<0.05)。试验组总有效率86.49%高于对照组75.68%,并发症发生率2.70%低于对照组21.62%,差异有统计学意义(χ2=5.260、5.284,P<0.05)。结论采用去骨瓣减压术治疗重型颅脑创伤可以减少术中出血量,缩短手术时间与住院时间,有效降低颅内压,降低病残率与病死率,与常规外伤大骨瓣减压术相比疗效更佳。

Objective To observe and evaluate the clinical effect of decompressive craniectomy for severe traumatic brain injury.Methods The patients with severe traumatic brain injury admitted to the hospital from March 2015 to September 2019 were convenient selected.74 cases were selected as the subjects of this study.The system was randomly numbered,the odd numbers were the experimental group,and the even numbers were the control group.The experimental group was treated with modified craniectomy decompression,and the control group was treated with conventional trauma decompression.The surgical indicators,intracranial pressure levels before and after the operation,clinical efficacy and the incidence of complications were compared between the two groups.Results After operation,the intracranial pressure level of the experimental group was 3 days(16.02±2.13)mmHg and one week(14.70±0.28)mmHg was significantly lower than the control group(24.12±2.08)mmHg,(20.88±2.22)mmHg,and the operation time of the experimental group was(48.62±10.82)min,intraoperative blood loss(96.05±16.11)mL,hospitalization time(14.70±0.28)d,less than the control group(71.62±11.67)min,(124.68±15.76)mL,(21.60±0.33)d,the difference is statistically significant(P<0.05).Conclusion The use of decompressive craniectomy for severe craniocerebral trauma can reduce the amount of intraoperative blood loss,shorten the operation time and hospital stay,effectively reduce intracranial pressure,reduce the rate of sickness and mortality,and compare with conventional large bone craniectomy for trauma,it has better curative effect.