标准大骨瓣减压术+额颞叶部分切除手术治疗双侧瞳孔散大脑疝患者的临床效果

Standard large craniectomy combined with partial frontotemporal lobectomy in treatment of patients with bilateral mydriatic cerebral hernia

目的分析标准大骨瓣减压术+额颞叶部分切除术治疗双侧瞳孔散大脑疝患者的临床效果。方法选择2018年8月至2021年8月罗定市人民医院收治的双侧瞳孔散大脑疝患者60例(包括重型颅脑外伤、脑出血等患者),并经头颅CT和/或MRI确诊,随机数字表法将其分为对照组[男20例,女10例,年龄(36.64±5.89)岁]和观察组[男21例,女9例,年龄(36.85±5.79)岁],各30例。对照组标准大骨瓣减压术治疗;观察组在对照组治疗基础上,术中做额颞叶部分切除治疗。比较两组临床效果。采用t检验和χ^(2)检验。结果两组患者治疗前格拉斯哥昏迷量表(GCS)评分差异无统计学意义(t=0.3725,P>0.05);治疗后7、14、28 d时,观察组GCS评分均高于对照组(t=3.9251、5.8234、7.6017,均P<0.05)。两组患者治疗前Barthel指数评分差异无统计学意义(t=0.5718,P>0.05);治疗后7、14、28d时,观察组Barthel指数评分均高于对照组(t=5.8246、13.7169、15.0826,均P<0.05)。两组患者治疗前神经功能缺损评分差异无统计学意义(t=0.5281,P>0.05),治疗后28 d时,观察组神经功能缺损评分低于对照组(t=14.3095,P<0.05);观察组总有效率为93.33%(28/30),明显高于对照组的73.33%(22/30)(χ^(2)=4.3200,P<0.05);观察组总不良反应发生率为6.67%(2/30),明显低于对照组的33.33%(10/30)(χ2=6.6667,P<0.05),而生存率显著高于对照组[23.33%(7/30)比6.67%(2/30),χ^(2)=3.2680,P<0.05]。结论标准大骨瓣减压术+额颞叶部分切除术治疗双侧瞳孔散大脑疝患者显著提高临床疗效及患者生存率,且大大改善患者GCS评分及Barthel指数评分,有效降低神经功能缺损评分及患者不良反应发生率,值得基层医院大力推广应用。

Objective To analyze the clinical effect of standard large craniectomy combined with partial frontotemporal lobectomy in the treatment of in patients with bilateral mydriatic cerebral hernia.Methods From August 2018 to August 2021,60 patients with bilateral mydriatic cerebral hernia(including patients with severe craniocerebral trauma,cerebral hemorrhage,etc.)admitted to our hospital were selected,and were confirmed by cranial CT and/or MRI.The patients were divided into a control group[20 males and 10 females who were(36.64±5.89)years old]and an observation group[21 males and 9 females who were(36.85±5.79)years old]by the random number table method,with 30 cases in each group.The control group were treated by standard large craniectomy,and the observation group by standard large craniectomy and partial frontotemporal lobectomy.The clinical effects were compared between these two groups.t test and χ^(2) test were applied.Results There was no statistical difference in the score of Glasgow Coma Scale(GCS)between these two groups before the treatment(t=0.3725,P>0.05).Seven,fourteen,and twenty-eight days after the treatment,the scores of GCS in the observation group were higher than those in the control group(t=3.9251,5.8234,and 7.6017;all P<0.05).There was no statistical difference in the score of Barthel Index between these two groups before the treatment(t=0.5718,P>0.05).Seven,fourteen,and twenty-eight days after the treatment,the scores of Barthel Index in the observation group were higher than those in the control group(t=5.8246,13.7169,and 15.0826;all P<0.05).There was no statistical difference in the neurological deficit score between the two groups before the treatment(t=0.5281,P>0.05).Twenty-eight days after the treatment,the neurological deficit score in the observation group was lower than that in the control group(t=14.3095,P<0.05).The total effective rate of the observation group was 93.33%(28/30),which was significantly higher than that of the control group[73.33%(22/30)](χ^(2)=4.3200,P<0.05).The incidence of adverse reactions in the observation group was significantly lower than that in the control group[6.67%(2/30)vs.33.33%(10/30),χ^(2)=6.6667,P<0.05].The survival rate in the observation group was significantly higher than that in the control group[23.33%(7/30)vs.6.67%(2/30),χ^(2)=3.2680,P<0.05].Conclusion Standard large craniectomy combined with partial frontotemporal lobectomy in the treatment of patients with bilateral mydriatic cerebral hernia can significantly improve the clinical efficacy,the survival rate,and their GCS score and Barthel index score,and effectively reduce their neurological deficit score and the Incidence of adverse reactions,so it is worth being generalized in primary hospitals.