扩大翼点入路治疗重型复合型硬膜下血肿30例的临床分析

Clinical Analysis of the Enlarged Pterional Approach in the Treatment of 30 Cases of Severe Compound Subdural Hematoma

目的分析重型复合型硬膜下血肿患者采取扩大翼点入路手术治疗的临床效果及应用价值。方法此次研究时间范围确立于2015年6月—2020年3月,随机抽选该院收治确诊为重型复合型硬膜下血肿患者60例作为研究目标,根据入院时间先后顺序进行分组,对照组(30例)采取常规颞顶或额颞顶马蹄形切口入路手术治疗,观察组(30例)采取扩大翼点入路手术治疗,评估两组术后疗效,测量各组患者术后2 h、1 d、3 d、7 d、10 d颅内压变化,评估各组患者治疗后昏迷指数评分,分析统计学差异性。结果此次观察组患者临床治疗总疗效96.67%明显优于对照组,差异有统计学意义(χ2=4.71,P<0.05),术后2 h两组患者颅内压指标,差异无统计学意义(P>0.05),术后1 d、3 d、7 d、10 d观察组患者颅内压指标均明显低于对照组,差异有统计学意义(P<0.05)。另外,术后观察组患者睁眼反应评分(3.28±0.24)分、语言反应评分(4.69±0.15)分、肢体运动评分(5.56±0.33)分明显高于对照组,差异有统计学意义(t=20.93、64.43、21.04,P<0.05)。结论对于重型复合型硬膜下血肿患者采取扩大翼点入路手术治疗效果确切,能够有效降低患者颅内压,改善病症表现。

Objective To analyze the clinical effect and application value of enlarged pterional approach in patients with severe compound subdural hematoma.Methods The study time frame was established from June 2015 to March 2020.Sixty patients diagnosed with severe complex subdural hematoma in the hospital were randomly selected as the research target,and grouped according to the order of admission time.The control group(30 cases)was treated with conventional temporoparietal or frontotemporal horseshoe-shaped incision approach,and the observation group(30 cases)was treated with enlarged pterional approach.The postoperative curative effect of the two groups was evaluated.The changes of intracranial pressure in each group were measured at 2 h,1 d,3 d,7 d,and 10 d after the operation,and the coma index scores of the patients in each group after treatment were evaluated,and statistical differences were analyzed.Results The total clinical treatment effect of the observation group 96.67%was better than that of the control group,the difference was statistically significant(χ2=4.71,P<0.05).There was no significant difference in intracranial pressure between the two groups 2 h after surgery(P>0.05).After 1 d,3 d,7 d,10 d,the intracranial pressure indexes of the observation group were significantly lower than those of the control group(P<0.05).In addition,the eyes open response score(3.28±0.24)points,language response score(4.69±0.15)points,and limb movement score(5.56±0.33)points of the observation group were significantly higher than those of the control group,the difference was significant(t=20.93,64.43,21.04,P<0.05).Conclusion For patients with severe compound subdural hematoma,the expanded pterional approach has a definite therapeutic effect,which can effectively reduce the intracranial pressure and improve the symptoms of the patient.