摘要
目的 探讨标准大骨瓣减压术治疗重型颅脑损伤的临床疗效。方法 选择2013-06—2015-03在沈阳市红十字会医院就诊的重型颅脑损伤患者92例,所有患者格拉斯哥昏迷评分（GCS）≤8分,将所有患者随机分为观察组与对照组,每组各46人,术前12 h禁食禁水,完善术前准备,脱水、利尿、止血、补液等处置,对照组行常规骨瓣开颅减压术,观察组行标准大骨瓣减压术,术后严密观察患者生命体征,给予两组患者常规抗感染、止血药,降颅压、利尿、营养脑细胞、吸氧等对症支持治疗。对比术前、术后1 d、术后3 d、术后7 d的颅内压,并根据格拉斯哥预后评分（GOS）对患者的预后进行评价。结果 两组患者术前颅内压比较差异无统计学意义,具有可比性（P〉0.05）。术后两组患者的颅内压均有明显降低,差异具有统计学意义（P〈0.05）,两组患者的颅内压在1 d、3 d、7 d呈现递减趋势,但观察组术后1 d、3 d、7 d的颅内压均明显优于对照组,差异具有统计学意义（P〈0.05）,对比两组患者GOS评分,观察组Ⅰ~Ⅲ级占22.4%（11/49）,其中死亡4例（占8.2%）,Ⅳ~Ⅴ级77.6%（38/49）,而对照组Ⅰ~Ⅲ级占40.8%（20/49）,其中死亡10例（占20.4%）,Ⅳ~Ⅴ级59.2%（29/49）,观察组疗效明显好于对照组,组间差异具有统计学意义（P〈0.05）。结论 标准大骨瓣减压术治疗重型颅脑损伤,能有效降低死亡率,疗效佳。
Objective To study the clinical effects of standard large trauma craniotomy in the treatment of severe craniocerebral injury.Methods 92 sufferers with severe craniocerebral injury at Shenyang Red Cross Hospital from June 2013 to March 2015 whose Glasgow Coma Scale（GCS） was~〈8 were selected and randomly divided into obser- vation group and control group with 46 cases in each group.Fasting for solids and liquids 12 hours before surgery and preoperative preparation such as dehydration, diuresis, hemostasis and fluid infusion was completed.The control group were given conventional bone flap decompressive craniectomy, while the observation group were given standard large trauma craniotomy.The vital signs of both groups were closely observed after surgery, and all sufferers were given treatments such as conventional anti-infection, hemostatics, intracranial pressure reduction, diuresis ,nutrition of brain cells, and oxygen uptake.Intracranial pressure before surgery, one day after surgery, three days after surgery, and seven day after surgery was compared, and Glasgow Outcome Scate（GOS） was adopted to evaluate the prognosis of the suf- ferers. Results Before surgery, intracranial pressure in both groups showed no difference of statistical significance with comparability （P 〉 0.05）.After surgery, intracranial pressure in both groups clearly reduced with differences of statistical significance（P〈0.05）.Intracranial pressure in both groups presented decline trend on the 1st, 3rd,and 7th day,while the observation group was clearly superior to the control group with differences of statistical significance（P〈0.05）. GOS scores showed that in the observation group, level Ⅰ-Ⅲ accounted for 22.4%（11/49）, with 4 cases of death（ac- counting for 8.2%）, and level Ⅳ- Ⅴ accounted for 77.6%（38/49）, while in the control group, level Ⅰ - Ⅲ accounted for 40.8%（20/49）, with 10 cases of death（accounting for 20.4%）, and level Ⅳ- Ⅴ accounted for 59.2%（29/49）.The observation group was clearly superior to the control group in terms of curative effect, with differences of statistical significance（P〈 0.05）.Conclusion Standard large trauma craniotomy in treatment of severe craniocerebral injury can effectively reduce the death rate with fine curative effect.
出处
《中国疗养医学》
2016年第5期457-459,共3页
Chinese Journal of Convalescent Medicine
关键词
标准大骨瓣减压术
重型颅脑损伤
预后
Standard large trauma craniotomy
Severe craniocerebral injury
Prognosis
