外伤性标准大骨瓣开颅术后结合亚低温抢救重型颅脑损伤的研究

Standard large trauma craniotomy combining with moderate hypothermia in the emergency treatment of patients with severe head injuries

目的 探讨外伤性标准大骨瓣开颅术结合亚低温对重型颅脑损伤的治疗效果。方法 对急性重型颅脑损伤患者 (GCS≤ 8) ,治疗组采用外伤性标准大骨瓣开颅术 ,术后即给予亚低温冬眠治疗 5～ 7d ;对照组仍采用传统的治疗方法。比较两组死亡率、GCS、GOS和颅内压 (ICP)。结果 治疗组GCS、GOS高于对照组 ,死亡率、ICP低于对照组。结论 尽早行外伤性标准大骨瓣开颅术并充分内、外减压 ,术后尽早给予亚低温冬眠治疗 ,对降低急性重型颅脑损伤的死亡率、致残率 。

Objective To evaluate the therapeutic efficacy of the method of standard large trauma craniotomy in combination with therapeutic moderate hypothermia.Method Patients with acute severe head injuries (GCS≤8)were assigned into two groups:Group I,30 cases(average GCS≤ 5.38) received standard large trauma craniotomy and moderate hypothermia for 5-7 days;Group Ⅱ,30 cases(average GCS≤5.46)were treated with traditional treatment as control.Mortality,GCS,GOS and intracranial pressure (ICP) were compared between these two groups.Result Both the GCS and GOS were higher in the group Ⅰ than group Ⅱ;while the mortality and ICP were obviously lower in the group Ⅰ than that of the control group.Conclusions Early standard large trauma craniotomy plus adequate decompression followed by postoperative therapeutic moderate hypothermia would be helpful in reducing the mortality moderate and morbidity of patients with severe head injuries,their level of living accommodation were improved as well.