双侧去骨瓣减压手术对对冲性颅脑损伤治疗效果的临床研究

Clinical study on the curative effect of bilateral bone flap decompressive craniectomy in treating contrecoup injury of the brain

目的探讨双侧去骨瓣减压开颅手术较单侧去骨瓣减压开颅手术对对冲性颅脑损伤的治疗效果.方法选取80例我院2016年10月1日至2018年10月31日期间的对冲性颅脑损伤患者进行研究,采用随机数字表法分组,对照组和观察组各为40例.前者行单侧去骨瓣减压开颅术,予以后者双侧去骨瓣减压开颅术,比较两组临床疗效、并发症、颅内压、脑摄氧量和脑血流指标.结果观察组临床总有效率高于对照组(P<0.05),并发症发生率低于对照组(P<0.05);观察组与对照组术前颅内压、脑摄氧量无差异(P>0.05).术前观察组与对照组在大脑中动脉收缩期峰值流速、平均血流速度、搏动指数等脑血流指标上无差异(P>0.05).观察组术后大脑中动脉收缩期峰值流速、平均血流速度和脑摄氧率相比于对照组明显上升(P<0.05,P<0.01),颅内压和搏动指数相比于对照组明显下降(P<0.01).术后两周观察组GCS评分较对照组改善明显(P<0.05),术后6月GOS评分显示观察组良好预后率总体优于对照组(P<0.05).结论双侧去骨瓣减压开颅手术治疗对冲性颅脑损伤的效果优于单侧去骨瓣减压开颅手术,安全性高,值得推广.

Objective Exploring therapeutic effect of bilateral bone flap decompressive craniectomy compared with unilateral decompressive craniectomy in the treatment of brain contralateral injury.Methods A total of 80 patients with contrecoup craniocerebral injury in our hospital admitted from October 1,2016 to October 31,2018 were selected and then included in the study.Patients were divided into control group(40 cases)and observation group(40 cases)by the method using the table of random number.Unilateral bone flap decompression craniotomy was performed in the control group while bilateral bone flap decompression craniotomy was implemented in the observation group.Furthermore,clinical efficacy,complications,intracranial pressure,brain oxygen uptake and cerebral blood flow indexes between above-mentioned two groups were put into comparasion.Results The total clinical effective rate of the observation group was higher than that of the control group(P<0.05),and incidence rate of complications was the opposite(P<0.05).There was no difference in preoperative intracranial pressure and brain oxygen uptake between the observation group and the control group.Besides,there was also no distinction between two groups in cerebral blood flow indicators,including preoperative peak systolic flow velocity in the middle cerebral artery,average blood flow velocity and pulsatility index.Compared with control group,the peak systolic flow velocity in the middle cerebral artery,average blood flow velocity and the rate of cerebral oxygen uptake of the observation group significantly increased(P<0.05,P<0.01),while intracranial pressure and pulsatility index apparently decreased(P<0.0l).In contrast to control group,GCS scores of observation group two weeks after surgery indicated significant improvement(P<0.05).Six months after surgery,GOS score suggested that the overall good prognosis rate of the observation group was better than that of the control group(P<0.05).Conclusion Compared with unilateral bone flap decompressive craniectomy,bilateral bone flap decompressive craniectomy demonstrated better clinical effect in treating contralateral brain injury in view of its high security,which deserved promotion.