标准大骨瓣减压术治疗脑疝的临床疗效分析

Analysis of Clinical Efficacy of Standard Decompressive Craniectomy for Treatment of Cerebral Hernia

目的探讨标准大骨瓣减压术对脑疝的临床治疗效果。方法整群选择该院2012年3月—2014年7月收治的脑疝患者86例为研究对象,随机分为对照组43例,采取常规去骨瓣开颅术治疗,观察组43例,实施标准大骨瓣减压术治疗,对两组患者手术指标及术后恢复状况相关指标进行对比分析。结果观察组手术时间及术后恢复意识时间明显较对照组短,观察组术中出血量及引流量明显低于对照组,差异有统计学意义(P<0.05);治疗前,两组患者GCS及CSS、MMSE评分无差异,经治疗后,两组患者评分均有改善,但是观察组评分明显优于对照组(P<0.05);对两组患者治疗前后应激状态及颅内压水平比较,两组患者治疗前的颅内压、血胰岛素水平及血糖水平无差异,经干预后,两组患者均有改善,但是观察组优于对照组(P<0.05)。结论标准大骨瓣减压术对脑疝治疗的安全性高,术后恢复快,有助于精神及神经功能恢复,降低颅内压及机体应激状态,利于远期预后,值得临床推广。

Objective To investigate the clinical curative effect of standard decompressive craniectomy for treatment of cerebral hernia. Methods 86 patients with cerebral hernia admitted to our hospital between March 2012 and July 2014 were selected as the research object and randomized to receive routine large trauma craniotomy(the control group, n =43) or standard decompressive craniectomy(the observation group, n=43). Then we comparatively analyzed the surgical parameters and postoperative parameters related to recovery of the two groups. Results The operation duration was shorter, the consciousness recovery after operation was earlier, and the intraoperative blood loss and drainage volume were less in the observation group than in the control group, and the differences were statistically significant(P<0.05); there was no difference between the two group before operation in GCS, CSS and MMSE score, which improved in all patients but were better in the observation group than in the control group after operation(P<0.05);no difference was found between the two group before operation in intracranial pressure, blood insulin and blood sugar levels under stress situation, which improved in all the patients but were better in the observation group than in the control group after intervention(P<0.05). Conclusion With higher safety and quick recovery, standard decompressive craniectomy for treatment of cerebral hernia not only is beneficial to the recovery of mental and neurological function, but also can improve intracranial pressure and stress situation and is conducive to the long-term prognosis, therefore it is worthy of clinical promotion.