本文選題：重型顱腦損傷 + 骨瓣減壓控制術(shù)��； 參考：《國際神經(jīng)病學(xué)神經(jīng)外科學(xué)雜志》2017年04期

【摘要】：目的探討腰大池持續(xù)引流術(shù)聯(lián)合骨瓣減壓控制術(shù)治療對(duì)重型顱腦損傷患者并發(fā)癥和預(yù)后的影響,以期為優(yōu)化該類患者外科治療提供參考性依據(jù)。方法選取2013年2月~2016年4月我院收治的重型顱腦損傷患者184例,按數(shù)字隨機(jī)表法分為試驗(yàn)組和對(duì)照組,各92例,對(duì)照組患者采取骨瓣減壓控制術(shù)治療,試驗(yàn)組患者則在對(duì)照組患者的基礎(chǔ)上聯(lián)合腰大池持續(xù)引流術(shù)治療,分別于術(shù)后3d、5d、7d檢測患者顱內(nèi)壓(ICP),于術(shù)后6個(gè)月時(shí)采格拉斯哥預(yù)后評(píng)分(GPS)評(píng)估兩組患者預(yù)后情況,詳細(xì)記錄兩組患者腦水腫、腦梗死等術(shù)后并發(fā)癥發(fā)生情況,并進(jìn)行組間比較。結(jié)果試驗(yàn)組患者術(shù)后3d、5d、7d ICP值均明顯低于對(duì)照組患者,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后3d、5d、7d時(shí)試驗(yàn)組患者GCS評(píng)分均明顯高于對(duì)照組患者,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);與對(duì)照組患者比較,試驗(yàn)組患者術(shù)后腦水腫發(fā)生率明顯降低,腦水腫程度也明顯減輕,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);與對(duì)照組患者比較,試驗(yàn)組患者術(shù)后腦梗死發(fā)生率明顯降低,且梗死體積也明顯縮小,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后6個(gè)月時(shí),試驗(yàn)組患者預(yù)后良好率、預(yù)后不良率和死亡率分別為59.78%(55/92)、33.70%(31/92)、6.52%(6/92),對(duì)照組患者分別為39.13%(36/92)、50.00%(46/92)、10.87%(10/92),兩組患者術(shù)后預(yù)后情況差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論腰大池持續(xù)引流術(shù)聯(lián)合骨瓣減壓控制術(shù)治療對(duì)重型顱腦損傷患者的療效顯著,可有效降低ICP,改善預(yù)后,降低術(shù)后并發(fā)癥的發(fā)生,效果優(yōu)于僅采用骨瓣減壓控制術(shù)。
[Abstract]:Objective to investigate the effect of lumbar cistern continuous drainage combined with bone flap decompression and control on the complications and prognosis of patients with severe craniocerebral injury in order to provide reference for optimizing surgical treatment of patients with severe craniocerebral injury. Methods 184 patients with severe craniocerebral injury admitted in our hospital from February 2013 to April 2016 were randomly divided into two groups: experimental group (n = 92) and control group (n = 92). Patients in control group were treated with bone flap decompression and control. The patients in the trial group were treated with continuous lumbar cistern drainage on the basis of the control group. The intracranial pressure (ICP) was measured at 3 days, 5 days and 7 days after operation. Glasgow prognosis score (GPSs) was used to evaluate the prognosis of the two groups at 6 months after operation. The postoperative complications such as cerebral edema and cerebral infarction were recorded in detail and compared between the two groups. Results the value of ICP in the trial group was significantly lower than that in the control group on the 3rd and 5th day after operation, the difference was statistically significant (P 0.05), the GCS score of the trial group was significantly higher than that of the control group on the 3rd day after operation, the difference was statistically significant (P 0.05), and the difference was significant compared with the control group. The incidence rate of postoperative cerebral edema and the degree of cerebral edema were significantly reduced in the trial group, and the difference was statistically significant (P 0.05), compared with the patients in the control group, the incidence of postoperative cerebral infarction in the trial group was significantly lower than that in the control group. The infarct volume was also significantly reduced, and the difference was statistically significant (P 0.05), and at 6 months after operation, the patients in the trial group had a good prognosis. The rates of poor prognosis and mortality were 59.78% and 33.70%, respectively. There was a significant difference in postoperative prognosis between the two groups (P 0.05). The ratio of 36 / 92% in the control group was 39.13% / 92% in the control group, respectively, and the mortality rate was 59.78%. The difference of the postoperative prognosis between the two groups was statistically significant (P 0.05), and that in the control group was 39.13% / 92% or 50.005 / 10 / 92.The difference of postoperative prognosis between the two groups was statistically significant (P < 0.05). Conclusion Lumbar cistern continuous drainage combined with bone flap decompression and control has a significant effect on severe craniocerebral injury. It can effectively reduce ICP, improve prognosis and reduce postoperative complications. The effect is better than that of bone flap decompression and control only.
【作者單位】： 延安大學(xué)咸陽醫(yī)院神經(jīng)外科;
【分類號(hào)】：R651.15

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本文編號(hào)：1971128