基于Rotterdam CT评分评估的颅脑损伤术中控制性减压的临床应用价值

Clinical value of intraoperative controlled decompression in patients with traumatic brain injury based on Rotterdam CT score

目的观察控制性减压技术治疗以鹿特丹(Rotterdam)CT评分为评估基础的不同程度颅脑损伤(TBI)的临床效果。方法选取湖南省脑科医院神经外科自2019年9月至2022年9月收治的TBI后严重颅高压需行去骨瓣减压手术的患者100例,采用随机数字表法将患者分为试验组(控制性减压)和对照组(快速减压),每组50例。所有患者术前行Rotterdam CT评分辅助评估,术后3个月随访,比较2组患者术中各Rotterdam CT分值区间一过性脑膨出发生率及预后情况。结果试验组Rotterdam CT 4~6分的脑膨出发生率低于对照组,差异有统计学意义(P<0.05)。随访3个月,40例患者预后良好,其中试验组27例,对照组13例,试验组预后良好率高于对照组,差异有统计学意义(P<0.05)。试验组各Rotterdam CT分值段(5~6分)GOS评分均高于对照组,差异有统计学意义(P<0.05)。结论严重颅脑损伤患者术中脑膨出的发生与术前高颅压状态有关,对颅内压失代偿需去骨瓣患者采用分阶段、分步骤的控制减压操作,可明显降低围术期并发症的发生率,改善预后。

Objective To observe the clinical effect of controlled decompression technique on patients with different degrees of traumatic brain injury(TBI)based on Rotterdam CT score.Methods A total of 100 patients with severe TBI requiring decompressive craniectomy were selected from the Neurosurgery Department of Brain Hospital of Hunan Province from September 2019 to September 2022.The patients were randomly divided into an experimental group(controlled decompression)and a control group(rapid decompression)using a random number table method,with 50 patients in each group.All patients underwent preoperative Rotterdam CT score assisted evaluation,and were followed up for 3 months postoperatively to compare the incidence and prognosis of transient encephalocele in each Rotterdam CT score interval between the two groups of patients.Results The incidence of transient encephalocele in each Rotterdam CT score range(4-6 points)of the experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05).After a 3-month follow-up,40 patients had a good prognosis,including 27 in the experimental group and 13 in the control group.The good prognosis rate of the experimental group was higher than that of the control group,and the difference was statistically significant(P<0.05).The GOS scores of each Rotterdam CT score range(5-6 points)in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05).Conclusion The occurrence of intraoperative encephalocele in patients with severe TBI is closely related to the state of high intracranial pressure before operation.stage-by-stage and step-by-step control of decompression for patients with decompensated intracranial pressure can significantly reduce the incidence of perioperative complications and improve the prognosis.