控制性减压在治疗重型颅脑损伤中的应用

Application of controlled decompression in the treatment of severe traumatic brain injury

目的探讨控制性减压在治疗重型颅脑损伤(sTBI)的临床疗效。方法回顾性分析中南大学湘雅医学院附属海口医院神经外科自2018年9月至2021年9月应用控制性减压治疗的sTBI患者35例,设为控制性减压组;2015年1月至2018年1月应用常规开颅减压治疗的sTBI患者35例,设为常规性减压组。分析2组患者的临床资料、术后并发症、住院时间、住院费用及预后结果。结果控制性减压组患者的手术时间长于常规性减压组,恶性脑膨出比例明显低于常规性减压组,差异均有统计学意义(P>0.05)。控制性减压组患者术后并发症(脑积水和脑膨出)的发生率、住院时间及费用均明显低于常规性减压组患者,差异均有统计学意义(P>0.05)。随访6个月,控制性减压组患者中27例效果良好,3例重度残疾,3例植物生存状态,2例患者术后弥漫性脑肿胀死亡。35例常规减压组患者中18例效果尚可,8例重度残疾,4例植物生存状态,5例死亡。2组患者预后比较,差异有统计学意义(P<0.05)。结论控制性减压在治疗sTBI患者中效果明显,能改善部分患者的预后。

Objective To explore the clinical efficacy of controlled decompression in the treatment of severe traumatic brain injury(sTBI).Methods Thirty five patients with sTBI treated by applying controlled decompression surgery from September 2018 to September 2021 in Neurosurgery Department of Haikou Affiliated Hospital of Central South University Xiangya School of Medicine were enrolled into controlled decompression group,another 35 patients with sTBI treated by routine conventional decompression surgery from January 2015 to January 2018 were enrolled into conventional decompression group.The clinical data,complication,length of hospital stay,hospital costs and follow-up results of all cases were analyzed.Results The surgical time of patients in the controlled decompression group was longer than that in the conventional decompression group,and the proportion of malignant encephalocele was significantly lower than that in the conventional decompression group,with statistical significance(P>0.05).The incidence,hospitalization time,and cost of postoperative complications(hydrocephalus and encephalocele)in the controlled decompression group were significantly lower than those in the conventional decompression group,and the differences were statistically significant(P>0.05).Following up for 6 months,27 patients in the controlled decompression group achieved good results,3 patients had severe disability,3 patients had vegetative survival status,and 2 patients died of postoperative diffuse brain swelling.Among the 35 patients patients in the conventional decompression group,18 were effective,8 were severely disabled,4 were in vegetative state,and 5 died.There was a statistically significant difference in prognosis between the two groups(P<0.05).Conclusion Controlled decompression has a good effective in the treatment of patients with sTBI and could improve the prognosis of some patients.