浮动骨瓣减压术联合颅内压监测在颅脑手术的临床应用

Clinical Application of Floating Bone Flap Decompression Combined with Intracranial Pressure Monitoring in Craniocerebral Surgery

目的:探究浮动骨瓣减压术联合颅内压监测在颅脑手术中的应用价值。方法:回顾性分析2019年3月至2020年8月本院收治的98例颅脑损伤患者的临床资料,根据手术方式分为观察组53例和对照组45例,观察组患者接受浮动骨瓣减压术+颅内压监测治疗,对照组接受标准去骨瓣减压术+颅内压监测治疗。比较两组患者甘露醇使用时间与使用量、ICU时间,不同时间点颅内压、格拉斯哥昏迷指数(GCS),术后并发症和预后情况。结果:术后两组患者颅内压、GCS评分的组间和时间差异均具有统计学意义(P<0.05),GCS评分交互差异有统计学意义(P<0.05);观察组和对照组各时间点的颅内压比较无明显差异(P>0.05),术后7d,观察组的GCS评分高于对照组(P<0.05)。术后,观察组的甘露醇使用量多于对照组(P<0.05),两组患者的甘露醇使用时间和ICU时间治疗时间无明显差异(P>0.05);观察组患者的电解质紊乱、肾功能异常和切口疝等并发症的发生率均低于对照组(P<0.05),其他并发症发生率无明显差异(P>0.05);术后6个月,观察组的平均治疗费用明显低于对照组(P<0.05),两组患者的预后良好率无明显差异(P>0.05)。结论:浮动骨瓣减压术联合颅内压监测可有效降低颅脑损伤患者颅内压,在改善患者预后方面,与标准去骨瓣减压术效果相当,可降低术后并发症发生率,避免颅骨的二次修复,从而减轻患者经济负担。

Objective:To explore the application value of floating bone flap decompression combined with intracranial pressure monitoring in craniocerebral surgery.Methods:The clinical data of 98 patients with craniocerebral injury admitted to the hospital from March 2019 to August 2020 were retrospectively analyzed.According to different surgical methods,they were divided into an observation group(53 cases)and a control group(45 cases).The observation group was treated with floating bone flap decompression and intracranial pressure monitoring,while the control group was treated with standard decompressive craniectomy and intracranial pressure monitoring.The usage time and dose of mannitol,ICU hospital stay length,intracranial pressure at different time points,Glasgow Coma Scale(GCS),postoperative complications and prognosis were compared between the two groups.Results:There were statistically significant differences in intracranial pressure and GCS scores between the two groups and at different time points(P<0.05).The GCS scores showed statistically significant differences in termof interaction effect(P<0.05).There was no significant difference in intracranial pressure between the two groups at each time point(P>0.05),and the observation group had higher GCS scores than the control group 7 days after operation(P<0.05).After surgery,the dosage of mannitol was higher in the observation group than in the control group(P<0.05),but no significant differences were found in usage time of mannitol and ICU stay between the 2 groups(P>0.05).The incidences of complications such as electrolyte imbalance,renal dysfunction and incisional hernia were lower in the observation group than in the control group(P<0.05),but no significant differences were found between the 2 groups in the incidences of other complications(P>0.05).At 6 months after surgery,the observation group spent less on treatment than the control group(P<0.05),and no significant difference was found in the good prognosis rate between the 2 groups(P<0.05).Conclusion:Floating bone flap decompression combined with intracranial pressure monitoring can greatly reduce intracranial pressure in patients with craniocerebral injury.For prognosis,it is comparable to standard decompressive craniectomy.Also,it can reduce incidences of postoperative complications and avoid secondary cranial repair,thereby reducing the patient’s economical burden.