摘要
目的探究开颅血肿清除联合去骨瓣减压术治疗颅脑外伤(TBI)患者对格拉斯哥昏迷(GCS)评分及并发症的影响。方法选择2019年5月—2022年5月本院收治的93例TBI患者作为研究对象,根据手术方式分为对照组(49例)和观察组(44例)两组。对照组采用开颅血肿清除术,观察组采用开颅血肿清除加去骨瓣减压术。比较两组患者的手术疗效、血肿及再次出血情况,对比不同时间点颅内压GCS评分,并统计患者住院期间术后并发症发生情况,观察手术方案的安全性。结果观察组、对照组TBI患者手术总有效率分别为93.18%(41/44)和77.55%(38/49),观察组手术总有效率高于对照组(P<0.05);观察组血肿清除率高于对照组,再次出血率低于对照组(P<0.05);两组患者术后24 h、术后7 d的颅内压均低于术前,两组患者术后7 d颅内压低于术后24 h(P<0.05),观察组术后24 h、术后7 d的颅内压均低于对照组(P<0.05);两组患者术后7 d、术后14 d的GCS评分高于术前,两组患者术后14 d的GCS评分高于术后7 d(P<0.05),观察组术后7 d、术后14 d的GCS评分均高于对照组(P<0.05);观察组、对照组TBI患者术后并发症发生率分别为9.09%(4/44)、24.49%(12/49),观察组低于对照组(P<0.05)。结论开颅血肿清除联合去骨瓣减压术能够提高TB患者手术疗效,增加血肿清除率,减少再次出血的发生,同时改善患者昏迷程度,具有较高的安全性。
Objective To investigate the effect of craniotomy hematoma evacuation combined with decompressive craniectomy on Glasgow coma score(GCS)and complications in patients with traumatic brain injury(TBI).Methods A total of 93 TBI patients those were admitted to Suqian hospital of Nanjing drum tower Hospital group from May 2019 to May 2022 were selected as study subjects,and they were divided into control group and observation group according to the surgical method.Forty-nine cases in the control group were treated with craniotomy hematoma evacuation,while 44 cases in the observation group were treated with craniotomy hematoma evacuation combined with decompressive craniectomy.Results The total effective rates of TBI patients in the observation group and control group were 93.18%(41/44)and 77.55%(38/49),respectively,and the total effective rate in the observation group was higher than that in the control group(P<0.05).The hematoma clearance rate in the observation group was higher than that in the control group,and the re-bleeding rate was lower than that in the control group(P<0.05).The intracranial pressure of patients in both groups at 24h and 7d after operation was lower than that before operation,and the intracranial pressure of patients in both groups at 7d after operation was lower than that at 24 h after operation(P<0.05).The intracranial pressure of the observation group was lower than that of the control group at 24 h and 7 d after operation(P<0.05).The GCS scores of patients in the two groups at 7d and 14 d after surgery were higher than those before surgery,and the GCS scores of patients in the 2 groups at 14d after surgery were higher than those at 7d after surgery(P<0.05).The GCS scores of the observation group at 7 days after operation and at 14d after operation were higher than those in the control group(P<0.05).The postoperative complication rates of TBI patients in the observation group and control group were 9.09%(4/44)and 24.49%(12/49),respectively,and incidence of the observation group was lower than the control group(P<0.05).Conclusions Craniotomy hematoma removal combined with decompressive craniectomy could improve the surgical efficacy of TB patients,increase the hematoma clearance rate,reduce the occurrence of re-bleeding,and improve the degree of coma of the patients,with high safety.
作者
高明明
刘保华
袁璞
熊方令
刘厚强
Gao Mingming;Liu Baohua;Yuan Pu;Xiong Fangling;Liu Houqiang(Neurosurgery department,Suqian hospital of Nanjing drum tower hospital group,Suqian,Jiangsu,223800,China)
出处
《齐齐哈尔医学院学报》
2023年第2期118-121,共4页
Journal of Qiqihar Medical University
关键词
开颅血肿清除
去骨瓣减压术
颅脑外伤
GCS评分
Craniotomy hematoma removal
Decompressive craniectomy
Craniocerebral trauma
GCS score
