双额大骨瓣减压手术治疗脑外伤后难治性弥漫性脑肿胀患者的效果和安全性分析

Efficacy and safety analysis of double frontal decompressive craniectomy in the treatment of patients with refractory diffuse brain swelling after traumatic brain injury

目的探究双额大骨瓣减压手术治疗脑外伤后难治性弥漫性脑肿胀患者的效果和安全性。方法选取2018年1月至2020年9月本院收治的颅脑外伤后难治性弥漫性脑肿胀患者95例作为研究对象,随机分为对照组(n=48)和观察组(n=47)。对照组采用保守治疗,观察组采用双额大骨瓣减压手术治疗,比较两组治疗时间、颅内压变化、环池受压情况、预后情况及并发症发生率。结果观察组治疗时间短于对照组,差异有统计学意义(P<0.05)。入院时,两组颅内压比较差异无统计学意义;治疗后,观察组颅内压低于入院时,且低于对照组,差异有统计学意义(P<0.05)。观察组环池受压好转率高于对照组,环池受压无变化率低于对照组,差异有统计学意义(P<0.05);两组环池受压加重率比较差异无统计学意义。观察组预后轻型占比高于对照组,差异有统计学意义(P<0.05);两组预后中型、重型占比比较差异无统计学意义。两组并发症发生率比较差异无统计学意义。结论双额大骨瓣减压手术治疗脑外伤后难治性弥漫性脑肿胀患者疗效显著,可改善患者颅内压,预后较好,且安全性较高,值得临床推广应用。

Objective To investigate the effect and safety of double frontal decompressive craniectomy in the treatment of patients with refractory diffuse brain swelling after traumatic brain injury.Methods 95 patients with refractory diffuse brain swelling after traumatic brain injury treated in our hospital from January 2018 to September 2020 were selected as the research subjects,and they were randomly divided into the control group(n=48)and the observation group(n=47).The control group was treated with conservative treatment,and the observation group was treated with double frontal decompressive craniectomy,the treatment time,intracranial pressure changes,ambient cistern compression,prognosis and complication rate were compared between the two groups.Results The treatment time of the observation group was shorter than that of the control group,and the difference was statistically significant(P<0.05).At admission,there was no significant difference in intracranial pressure between the two groups;after treatment,the intracranial pressure was lower than that at admission and lower than that of the control group,and the difference was statistically significant(P<0.05).The ambient cistern compression improvement rate in the observation group was higher than that in the control group,and theambient cistern compression no change rate was lower than that in the control group,the difference was statistically significant(P<0.05);there was no significant difference in the ambient cistern compression exacerbation rate between the two groups.The proportion of mild prognosis in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of medium and severe prognosis between the two groups.There was no statistically significant difference in the incidence of complications between the two groups.Conclusion Double frontal decompressive craniectomy in the treatment of refractory diffuse brain swelling after traumatic brain injury has significant efficacy,can improve the intracranial pressure in patients with good prognosis,and has high safe,and is worthy of clinical promotion and application.