重型颅脑损伤标准大骨瓣减压术中采用逐步减压技术对神经功能及并发症的影响

Effects of stepwise decompression technique on nerve function and complications in severe craniocerebral injury during standard decompressive craniectomy

目的:探究标准大骨瓣减压术中采用逐步减压技术对重型颅脑损伤患者神经功能及并发症的影响。方法:将2016年1月至2022年12月期间收治于安远县人民医院行标准大骨瓣减压术联合逐步减压技术治疗的60例患者作为研究对象,根据随机数字表法分为观察组30例及对照组30例。对照组患者实施标准大骨瓣减压术中采用常规减压手术治疗,观察组患者实施标准大骨瓣减压术中采用逐步减压手术治疗。术前及术后7d、1m,分别比较两组患者的神经功能(美国国立卫生院卒中量表)、颅内压变化情况、损害程度(格拉斯哥昏迷量表);术后3m,比较两组患者的预后情况(格拉斯哥预后评分)、术后并发症情况(脑脊液漏、脑积水、急性脑膨出、颅内感染)。结果:治疗后,研究组患者的神经功能改善情况优于对照组(P<0.05);治疗后,研究组颅内压力、颅脑损害程度均低于对照组(P<0.05);治疗后,研究组预后效果均优于对照组(P<0.05);两组术后并发症发生情况未见显著差异(P>0.05)。结论:重型颅脑损伤标准大骨瓣减压术中采用逐步减压技术不仅可有效改善患者神经功能,还进一步提高预后效果。

Objective:To explore the effects of stepwise decompression technique on nerve function and complications in severe craniocerebral injury during standard decompressive craniectomy.Methods:Atotal of 60 patients undergoing standard decompressive craniectomy in Anyuan People's Hospital were enrolled as the research objects between January 2016 and December 2022.According to random number table method,they were divided into observation group(30 cases)and control group(30 cases).During standard decompressive craniectomy,control group was treated with routine decompression,while observation group was treated with stepwise decompression.The changes of nerve function(national institute health stroke scale),intracranial pressure and injury degree(Glasgow coma scale)before surgery,at 7 days and 1 month after surgery,prognosis(Glasgow outcome scale)at 3 months after surgery and postoperative complications(cerebrospinal fluid leakage,hydrocephalus,acute encephalocele,intracranial infection)in the two groups were compared.Results:After treatment,improvement of nerve function in study group was better than that in control group(P<0.05),intracranial pressure and craniocerebral injury were lower than those in control group(P<0.05),and prognosis was better than that in control group(P<0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion:The application of stepwise decompression technique can not only effectively improve nerve function,but also further improve prognosis of patients with severe craniocerebral injury during standard decompressive craniectomy.