不同去骨瓣减压开颅手术在重型对冲性颅脑外伤患者中的应用效果

Application effect of different decompressive craniotomy in the treatment of patients with severe contrecoup head injury

目的探究标准外伤大骨瓣减压术(STC)和双侧去骨瓣减压开颅手术治疗重型对冲性颅脑外伤患者的临床疗效。方法选取2018年3月至2020年8月本院收治的68例重型对冲性颅脑外伤患者作为研究对象,按照不同手术方式分为对照组和观察组,每组34例。对照组给予STC治疗,观察组给予双侧去骨瓣减压开颅术治疗,比较两组不同治疗阶段的颅内压、格拉斯哥昏迷评分(GCS)、术后并发症发生率及预后优良率。结果两组颅内压组间、时间、交互比较差异有统计学意义(P<0.05)。术前及术后1 d,两组颅内压比较差异无统计学意义;术后3、7 d,两组颅内压均低于术前及术后1 d,且观察组颅内压值均低于对照组,差异有统计学意义(P<0.05)。两组GCS组间、时间、交互比较差异有统计学意义(P<0.05)。术前及术后1 d,两组GCS评分比较差异无统计学意义;术后3、7 d,两组GCS评分均高于术前及术后1 d,且观察组均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为5.88%,低于对照组的23.53%,差异有统计学意义(P<0.05)。术后3个月,观察组预后优良率为67.65%,高于对照组41.18%,差异有统计学意义(P<0.05)。结论双侧去骨瓣减压开颅术治疗重型对冲性颅脑外伤,可加速降低颅内压,促进患者意识恢复,且并发症发生率较低,有利于改善预后,值得临床推广应用。

Objective To investigate the clinical efficacy of standard trauma craniotomy(STC)and bilateral decompression craniotomy in patients with severe contrecoup head injury.Methods Atotal of 68 patients with severe contrecoup head injury admitted to our hospital from March 2018 to August 2020 were selected as research subjects,and they were divided into control group and observation group according to different surgical methods,with 34 patients in each group.The control group was treated with STC and the observation group was treated with bilateral decompression craniotomy,the intracranial pressure and Glasgow coma score(GCS)at different treatment stages,postoperative complication rate and prognosis rate were compared between the two groups.Results There was significant difference of intracranial pressure between the two groups in inter-group,times,and interactions(P<0.05).At 1 d before and after surgery,there was no significant difference in intracranial pressure between the two groups;at 3 and 7 d after surgery,the intracranial pressure in both groups was lower than that before and 1 d after surgery,and the intracranial pressure values in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was significant difference of GCS between the two groups in times,and interactions(P<0.05).There was no significant difference in GCS scores between the two groups before and after surgery for 1 d;at 3 and 7 d after surgery,the GCS scores of both groups were higher than those before and 1 day after surgery,and the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).The complication rate in the observation group was 5.88%,which was lower than 23.53%in the control group,and the difference was statistically significant(P<0.05).3 months after surgery,the prognosis rate of the observation group was 67.65%,which was higher than 41.18%of the control group,and the difference was statistically significant(P<0.05).Conclusion Bilateral decompression craniotomy for the treatment of severe contrecoup head injury can accelerate the reduction of intracranial pressure,promote the recovery of patients'consciousness,and have a low complication rate,which is conducive to improving prognosis and worthy of clinical application.