预缝式关颅联合颅内压监测下控制性减压在PADBS手术中的作用探讨

Role of pre-suture craniotomy combined with controlled decompression under intracranial pressure monitoring in surgery for posttraumatic acute diffuse brain swelling

目的探讨预缝式关颅联合颅内压监测下控制性减压在外伤性急性弥漫性脑肿胀(PADBS)手术中的应用价值。方法选择湖州市第一人民医院神经外科自2015年2月至2019年12月收治的157例PADBS患者为研究对象,并将其中2017年6月前收治的采用颅内压监测下控制性减压手术治疗的68例患者纳入对照组,2017年6月后收治的采用预缝式关颅联合颅内压监测下控制性减压手术治疗的89例患者纳入试验组,回顾性对比分析2组患者间术中开颅时间、脑组织暴露时间、关颅时间、急性脑膨出发生率及伤后6个月格拉斯哥预后量表(GOS)评分的差异。结果试验组患者的术中开颅时间[(19.2±1.6)min]明显长于对照组[(15.4±1.4)min],脑组织暴露时间[(18.5±2.4)min]明显短于对照组[(26.3±2.2)min],关颅时间[(11.2±1.5)min]明显短于对照组[(18.3±2.1)min],急性脑膨出发生率(22.5%)明显低于对照组(38.2%),预后良好率(70.8%)明显高于对照组(50.0%),死亡率(6.7%)明显低于对照组(17.6%),差异均有统计学意义(P<0.05)。结论预缝式关颅联合颅内压监测下控制性减压能够缩短关颅时间及脑组织暴露时间,降低急性脑膨出发生率,更有效地改善PADBS患者的预后。

Objective To investigate the application value of pre-suture craniotomy combined with intracranial pressure monitoring in surgery for posttraumatic acute diffuse brain swelling(PADBS).Methods One hundred and fifty-seven patients with PADBS admitted to our hospital from February 2015 to December 2019 were chosen in our study;68 patients(control group),admitted to our hospital from February 2015 to June 2017,underwent controlled decompression under intracranial pressure monitoring;and 89 patients(treatment group),admitted to our hospital from June 2017 to December 2019,were performed pre-suture craniotomy combined with controlled decompression under intracranial pressure monitoring.The craniotomy time,brain tissue exposure time,cranial closure time,incidence of acute encephalocele,and Glasgow outcome scale(GOS)scores at 6 months after injury were retrospectively analyzed and compared between the two groups.Results As compared with those in the control group,the patients in the treatment group had significantly longer intraoperative craniotomy time([19.2±1.6]min vs.[15.4±1.4]min),significantly shorter exposure time of brain tissues([18.5±2.4]min vs.[26.3±2.2]min),significantly shorter time of cranial closure([11.2±1.5]min vs.[18.3±2.1]min),and statistically lower incidence of acute encephalocele(22.5%vs.38.2%),P<0.05).The good prognosis rate of the treatment group(70.8%)was significantly higher than that of the control group(50.0%),and the mortality rate(6.7%)was statistically lower than that of the control group(17.6%,P<0.05).Conclusion Pre-suture craniotomy combined with controlled decompression under intracranial pressure monitoring can shorten the time of cranial closure and brain tissue exposure,reduce the incidence of acute encephalocele,and ultimately improve the prognosis of patients with posttraumatic acute diffuse brain swelling.