开放性颅脑损伤早期临床救治策略

Early clinical treatment strategies for open traumatic brain injury

目的探讨开放性颅脑损伤(TBI)早期临床救治策略。方法选取联勤保障部队第九○○医院神经外科自2010年6月至2020年1月收治的50例开放性TBI患者的临床资料,根据手术时机分为早期组(<6 h,25例)和晚期组(6~12 h,25例)。对12例合并颅底骨折的患者一期行颅底重建。比较2组患者术后72 h的GOS评分、临床结局恶化情况及术后并发症发生情况。结果12例合并颅底骨折的患者均一期行颅底重建,未出现脑膜脑膨出、脑脊液漏等并发症。早期组术后72 h GOS评分总体高于晚期组,差异有统计学意义(P<0.05);早期组术后72 h死亡、TBI加重、颅内感染、应激性溃疡、癫痫、肺部感染等术后并发症发生率低于晚期组,差异有统计学意义(P<0.05)。结论对于开放性TBI患者,早期手术、一期行颅底重建有助于改善患者预后,降低术后并发症的发生率。

Objective To explore the early clinical treatment strategy of open traumatic brain injury(TBI).Methods The clinical data of 50 patients with open TBI treated in Neurosurgery Department of the 900th Hospital of Joint Logistics Team from June 2010 to January 2020 were selected.According to the operation time,they were divided into the early group(<6 h,25 cases)and the late group(6-12 h,25 cases).Twelve patients with skull base fracture phaseⅠwere treated with skull base reconstruction.After 72 h,the GOS score,clinical deterioration outcome and postoperative complications were compared between the two groups.Results All 12 patients with skull base fracture underwent skull base reconstruction in phaseⅠ,and there were no complications such as meningoencephalocele and cerebrospinal fluid leakage.The postoperative 72 h GOS score in the early group was higher than in the late group.The incidence of postoperative 72 h death,severe TBI,intracranial infection,stress ulcer,epilepsy and pulmonary infection in the early group was lower than in the late group(P<0.05).Conclusion For open TBI,eraly operation and skull base reconstruction in phaseⅠcan effectively reduce the postoperative complications and improve the prognosis of patiens.