半球颅骨骨瓣减压术亚低温辅助治疗重型颅脑创伤临床疗效与预后观察

The clinical efficacy and prognosis of hemisphere skull bone flap decompression and mild hypothermia treatment for severe craniocerebral trauma

共1626例重型颅脑创伤患者,分别接受半球颅骨骨瓣减压术辅助亚低温治疗和传统额颞顶叶大骨瓣减压术治疗。与传统减压术组比较,骨瓣减压术辅助亚低温治疗组患者术后第1、3、5和7天时颅内压显著降低(均P<0.05)、意识恢复快(均P<0.05),且术后3个月时预后良好(均P<0.05)。表明半球颅骨骨瓣减压术辅助亚低温治疗可以显著降低重型颅脑创伤患者病残率和病死率,提高术后生活质量、改善预后。

In this study, 1626 patients with severe craniocerebral trauma were assessed by Glasgow Coma Scale(GCS, 886 patients of 3-5 score and 740 of 6-8 score). Patients were divided into 2 groups. Ninety hundred and eleven patients(496 of 3-5 score and 415 of 6-8 score) underwent hemisphere calvarial bone flap decompression with auxiliary mild hypothermia(experiment group), and 715 patients(390 of 3-5 score and 325 of 6-8 score) underwent traditional frontal, temporal, parietal large traumatic craniotomy(control group). After operation the treatment of 2 groups was basically the same. Compared with control group, the intracranial pressure of experiment group on the 1st, 3rd, 5th and 7th days after surgery decreased significantly(P < 0.05, for all); the consciousness recovery time was significantly shorter(P <0.05, for all); the prognosis after 3 months was better(P <0.05, for all). Hemisphere calvarial bone flap decompression with auxiliary mild hypothermia treatment could significantly reduce the morbidity and mortality, and improve the quality of life and prognosis of patients with severe craniocerebral trauma.