阶梯性减压手术与传统开颅术对重型颅脑损伤患者不良事件及预后的影响比较

Comparison of effects of stepped decompression surgery and traditional craniotomy on adverse events and prognosis in patients with severe traumatic brain injury

目的比较阶梯性减压手术与传统开颅术对重型颅脑损伤(STBI)患者不良事件及预后的影响。方法选取2018年6月至2021年6月本院收治的60例STBI患者作为研究对象,采用随机数字表法分为观察组与对照组,各30例。对照组采用传统开颅术治疗,观察组采用阶梯性减压手术治疗。比较两组术中不良事件(弥漫性脑肿胀膨出、急性脑膨出、迟发性颅内血肿)发生情况、术后7 d不良事件(迟发性血肿、二次手术、病死)发生情况、术前和术后7 d昏迷状况[格拉斯哥昏迷评分(GCS)、格拉斯哥瞳孔状况评分(GCS-P)]及术后7 d、6个月预后状况[格拉斯哥预后评分(GOS)、美国国立卫生研究院卒中量表(NIHSS)评分]。结果观察组术中不良事件发生率低于对照组,差异有统计学意义(P<0.05);观察组术后7 d不良事件发生率低于对照组,差异有统计学意义(P<0.05);术后7 d,两组GCS、GCS-P评分均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);术后6个月,两组GOS、NIHSS评分均高于术后7 d,且观察组GOS评分高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05)。结论与传统开颅术相比,阶梯性减压手术治疗STBI能改善患者预后状况,减少术中及术后不良事件的发生,有利于患者术后恢复。

Objective To compare the effects of stepped decompression surgery and traditional craniotomy on adverse events and prognosis in patients with severe traumatic brain injury(STBI).Methods 60 patients with STBI admitted to our hospital from June 2018 to June 2021 were selected as the study subjects and they were divided into the observation group and the control group,with 30 cases in each group.The control group was given traditional craniotomy,and the observation group was given stepped decompression surgery.The occurrence of intraoperative adverse events(diffuse brain swelling bulging,acute encephalocele,delayed intracranial hematoma),occurrence of adverse events(delayed hematoma,secondary surgery,mortality)at 7 d after surgery,coma status(Glasgow coma scale[GCS]),Glasgow coma scale-pupil response[GCS-P])before and 7 d and prognosis status(Glasgow outcome score[GOS],National Institutes of Health stroke scale[NIHSS]score)at 7 d after surgery and at 6 months after surgery were compared between the two groups.Results The incidence rate of intraoperative adverse events in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence rates of adverse events at 7 d after surgery in the observation group were lower than that in the control group,and the difference was statistically significant(P<0.05).At 7 d after surgery,the scores of GCS and GCS-P of the two groups were higher those before surgery,and the observation group was higher than the control group,and the differences were statistically significant(P<0.05).At 6 months after surgery,the scores of GOS and NIHSS of the two groups were higher than those at 7 days after surgery,and the GOS score in the observation group was higher than that in the control group,while the NIHSS score was lower than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Compared with traditional craniotomy,stepped decompression surgery can improve the prognosis status,reduce the occurrence of intraoperative and postoperative adverse events,and facilitate the postoperative recovery of patients.