摘要
目的 探讨重型颅脑损伤,特别是以颞叶损伤为主的患者,在血肿清除去骨瓣减压术的基础上,将天幕裂孔切开,能否有效预防术后脑梗死的发生.方法 本研究共收集我科2011年1月～2013年1月重型颅脑损伤患者120例,随机分为实验组和对照组.实验组60例,行颅内血肿清除、去骨瓣减压术,同时将天幕裂孔切开约2 cm;对照组60例,仅行颅内血肿清除、去骨瓣减压术;所有患者术后常规行头颅CT检查,分别统计两组患者脑梗死发生例数、颅内压指数、甘露醇用量,格拉斯哥预后分级（GOS）评级,并进行统计学分析.结果 实验组术后脑梗死发生率（6.7％）,颅内压指数（11.30 ±2.62）,甘露醇使用次数（34.00 ±2.90）均小于对照组[分别是13.3％、（15.70 ±2.65）、（45.38±3.42）],差异有统计学意义（P＜0.05）;实验组GOS评级明显优于对照组.结论 对于重型颅脑损伤患者,行颅内血肿清除、去骨瓣减压术,同时将天幕裂孔切开,可以降低术后脑梗死的发生率,提高生存率,改善预后.
Objective To explore the value of tentorium cerebelli hiatus incision in preventing cerebral infarction after operation for severe traumatic brain injury.Methods Totally 120 patients with severe traumatic brain injury who were admitted into our hospital from Jan.2011 to Jan.2013 were divided into 2 groups：treatment group （n =60） treated with the removal of hematomas,decompressive craniotomy and tentorium cerebelli hiatus incision,and control group （n =60） with the same treatment except for tentorium cerebelli hiatus incision.All patients underwent head CT after operation.The incidence of cerebral infarction,intracranial pressure index,the dosage of mannitol and Glasgow Outcome Scale were compared and statistically analyzed.Results The incidence of cerebral infarction（6.7％）,intracranial pressure index （11.30 ± 2.62）,the application times of mannitol （34.00 ± 2.90） in the treatment group were lower than those in the control group [13.3％,（15.70 ± 2.65）,（45.38 ± 3.42）,respectively] （P ＜0.05）.Glasgow Outcome Scale was obviously better in the treatment group than that in the control group （P ＜ 0.05）.Conclusion Tentorium cerebelli hiatus incision is a good approach for the treatment of severe traumatic brain injury,which can reduce the incidence of cerebral infarction and improve patients＇ survival and prognosis.
出处
《创伤外科杂志》
2014年第5期407-410,共4页
Journal of Traumatic Surgery
基金
国家临床重点专科建设项目经费资助(财社[2011]170号)
关键词
颅脑损伤
天幕裂孔
脑梗死
brain injury
tentorium cerebelli hiatus
cerebral infarction
