标准大骨瓣开颅减压术与传统骨瓣开颅减压术在重型颅脑损伤治疗的应用比较

Comparison of standard large trauma craniotomy and traditional craniotomy decompression in the treatment of severe traumatic brain injury

目的 对比标准大骨瓣开颅减压术(standard large trauma craniotomy,SLTC)与传统骨瓣开颅减压术对重型颅脑损伤(severe traumatic brain injury,sTBI)患者的影响。方法 回顾性分析48例sTBI患者病例资料,按治疗措施不同分为对照组(24例,传统骨瓣开颅减压术)和观察组(24例,SLTC)。比较两组颅内压、脑氧代谢指标、并发症、预后情况。结果 术后7d,观察组颅内压为(14.30±1.59)mmHg,桡动脉-颈内静脉球部血氧含量差(arterial jugular vein oxygen content difference,Da-jvO_(2))为(50.39±3.01)ml/L,均低于对照组(18.41±2.01)mmHg、(55.22±3.72)ml/L;静脉血氧含量(oxygen saturation in venous blood,CjvO_(2))为(97.54±11.38)ml/L,动脉血氧含量(arterial oxygen content,CaO_(2))为(162.22±11.57)ml/L,高于对照组(88.75±9.21)ml/L、(153.24±9.75)ml/L;术后6个月,观察组格拉斯哥预后评分(Glasgow Outcome Scale,GOS)为(4.13±0.28)分,高于对照组(3.52±0.26)分,差异具有统计学意义(P<0.05);两组并发症相比,差异无统计学意义(P>0.05)。结论 SLTC能够更有效降低sTBI患者颅内压,调节脑氧代谢,有助于改善患者预后,有一定应用价值,值得临床进行推广应用。

Objective To compare the effects of standard large trauma craniotomy(SLTC)and traditional craniotomy decompression on patients with severe traumatic brain injury(sTBI).Methods The clinical data of 48 patients with sTBI were analyzed retrospectively.The patients were divided into two groups according to different treatment measures:the control group(24 patients,treated with traditional craniotomy decompression)and the observation group(24 patients,treated with SLTC).The intracranial pressure(ICP),cerebral oxygen metabolism indicators,complications,and prognosis were compared between the two groups.Results Seven days after surgery,the ICP was(14.30±1.59)mmHg and the arterial jugular vein oxygen content difference(Da-jvO2)was(50.39±3.01)ml/L in the observation group,both significantly lower than those in the control group[(18.41±2.01)mmHg and(55.22±3.72)ml/L,respectively].Meanwhile,the oxygen saturation in venous blood(CjvO2)was(97.54±11.38)ml/L and the arterial oxygen content(CaO2)was(162.22±11.57)ml/L in the observation group,both significantly higher than those in the control group[(88.75±9.21)ml/L and(153.24±9.75)ml/L,respectively].Six months after surgery,the Glasgow Outcome Scale(GOS)score in the observation group was(4.13±0.28),significantly higher than that in the control group[(3.52±0.26),P<0.05].There was no significant difference in complications between the two groups(P>0.05).Conclusions SLTC can effectively reduce ICP,regulate cerebral oxygen metabolism,and potentially reduce complications in patients with sTBI,thereby improving their prognosis.It demonstrates significant clinical value and is worthy of further popularization clinically.