摘要
目的研究去大骨瓣减压联合天幕裂孔切开对重型颅脑损伤合并脑疝患者神经功能及预后的影响。方法以2020年1月-2022年1月连云港市赣榆区人民医院收治的82例重型颅脑损伤合并脑疝患者为研究对象,采用随机数字表法分为对照组(41例)与观察组(41例)。对照组行去大骨瓣减压治疗,观察组采用去大骨瓣减压联合天幕裂孔切开治疗,比较两组围术期颅内压、脑代谢指标[脑灌注压(CCP)、脑氧摄取率(CEO_(2))、静脉血氧饱和度(SVO_(2))]、神经功能[神经功能缺损程度量表(NIHSS)评分]、术后并发症及预后情况。结果两组术后颅内压均低于术前,且观察组术后6 h、术后3 d颅内压均低于对照组(P<0.05);两组术后CCP、CEO_(2)、SVO_(2)均有升高,且观察组高于对照组(P<0.05);两组术后NIHSS下降,且观察组NIHSS评分低于对照组(P<0.05);观察组术后并发症发生率低于对照组,预后优良率高于对照组(P<0.05)。结论去大骨瓣减压联合天幕裂孔切开治疗重型颅脑损伤合并脑疝效果确切,可降低患者颅内压水平,恢复其脑代谢与神经功能,减少术后并发症风险,改善患者预后结局。
Objective To study the effect of large decompressive craniectomy combined with tentorium cerebelli hiatus incision on neurological function and prognosis in patients with severe traumatic brain injury complicated with cerebral herniation.Methods A total of 82 patients with severe traumatic brain injury complicated with cerebral hernia admitted to Ganyu District People's Hospital of Lianyungang City from January 2020 to January 2022 were divided into control group(41 cases)and observation group(41 cases)by random number table method.The control group was treated with large decompressive craniectomy,and the observation group was treated with large decompressive craniectomy combined with tentorium cerebelli hiatus incision.The perioperative intracranial pressure,cerebral metabolic indexes[cerebral perfusion pressure(CCP),cerebral extraction of oxygen(CEO_(2)),venous oxygen saturation(SVO_(2))],neurological function[NIH Stroke Scale(NIHSS)score],postoperative complications and prognosis were compared between the two groups.Results The intracranial pressure of the two groups after operation was lower than that before operation,and the intracranial pressure of the observation group at 6 h and 3 d after operation was lower than that of the control group(P<0.05).CCP,CEO_(2) and SVO_(2) increased in both groups after operation,and those in the observation group were higher than those in the control group(P<0.05).The postoperative NIHSS of the two groups decreased,and the NIHSS score of the observation group was lower than that of the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group,and the excellent and good rate of prognosis was higher than that in the control group(P<0.05).Conclusion Large decompressive craniectomy combined with tentorium cerebelli hiatus incision is effective in the treatment of severe traumatic brain injury complicated with cerebral hernia,which can reduce the intracranial pressure level,restore their brain metabolism and neurological function,reduce the risk of postoperative complications,and improve the prognosis of patients.
作者
霍利
丁立浩
嵇雪莱
HUO Li;DING Li-hao;JI Xue-lai(Department of Neurosurgery,Ganyu District People's Hospital,Lianyungang 222100,Jiangsu,China)
出处
《医学信息》
2023年第4期132-135,共4页
Journal of Medical Information
关键词
重型颅脑损伤
脑疝
去大骨瓣减压术
天幕裂孔切开术
颅内压
神经功能
Severe traumatic brain injury
Cerebral hernia
Large decompressive craniectomy
Tentorium cerebelli hiatus incision
Intracranial pressure
Neurological function
