硬腦膜減張縫合在神經(jīng)外科中的療效觀察
發(fā)布時(shí)間：2018-09-08 12:33
【摘要】：目的:通過(guò)分析神經(jīng)外科各種常見(jiàn)病原因造成的顱內(nèi)高壓,開(kāi)顱術(shù)中硬腦膜不能原位縫合所采取的硬腦膜減張縫合與非減張縫合的兩種手術(shù)方式,評(píng)估兩種手術(shù)方法的優(yōu)缺點(diǎn),為臨床選擇最佳的手術(shù)方式提供參考,進(jìn)一步改善手術(shù)質(zhì)量,提高患者的治療效果。方法:采取回顧性分析,通過(guò)收集延安大學(xué)附屬醫(yī)院神經(jīng)外科2009年07月-2014年01月期間進(jìn)行的開(kāi)顱去骨瓣減壓手術(shù)的病例96例,將所選取的病例隨機(jī)分為硬腦膜減張縫合組(實(shí)驗(yàn)組,n=46)與非減張組(對(duì)照組,n=50)。兩組患者術(shù)后均采取適度的降顱壓措施,同時(shí)給予營(yíng)養(yǎng)神經(jīng)、預(yù)防癲癇、腸外營(yíng)養(yǎng)支持、維持機(jī)體電解質(zhì)平衡、預(yù)防墜積性肺炎、防止應(yīng)激性潰瘍等對(duì)癥治療措施,復(fù)查頭顱CT明確病情變化。收集兩組患者的一般資料,術(shù)前GCS評(píng)分,手術(shù)時(shí)間及術(shù)中出血量,術(shù)后抗生素使用時(shí)間,腦脊液漏、感染、皮下積液、骨窗疝、癲癇等發(fā)生的情況,出院時(shí)應(yīng)用Barthel日常生活活動(dòng)能力量表評(píng)估日常生活活動(dòng)能力。采用SPSS17.0軟件對(duì)兩組數(shù)據(jù)進(jìn)行分析,找出差異以得到結(jié)論。結(jié)果:兩組患者的手術(shù)時(shí)間和術(shù)中出血量相比較無(wú)明顯統(tǒng)計(jì)學(xué)差異(P㧐0.05);與非減張組在術(shù)后癲癇、腦脊液漏、骨窗疝、皮下積液等并發(fā)癥的發(fā)病率相比,硬腦膜減張縫合組明顯優(yōu)于前者(P0.05);日常生活質(zhì)量評(píng)估(ADL):Barthel指數(shù)得分20分以上的患者硬腦膜減張縫合組明顯優(yōu)于非減張組(P㩳0.05),得分在20分以下的患者減張縫合組和非減張組無(wú)顯著差異(P㧐0.05)。結(jié)論:硬腦膜減張縫合可以有效降低顱內(nèi)高壓,降低術(shù)后癲癇、腦脊液漏、感染、皮下積液、骨窗疝的發(fā)生率,并能有效提高患者的預(yù)后效果。
[Abstract]:Objective: to evaluate the advantages and disadvantages of the two operative methods of dural tension-reduction suture and non-tension-free suture by analyzing the intracranial hypertension caused by various common diseases in neurosurgery, and to evaluate the advantages and disadvantages of the two surgical methods, in which the dura mater can not be sutured in situ during craniotomy. To provide a reference for clinical selection of the best operation, further improve the quality of surgery, improve the treatment of patients. Methods: by retrospective analysis, 96 cases of craniotomy and decompression of craniotomy were collected from Neurosurgery Department, affiliated Hospital of Yan'an University, from July 2009 to January 2014. The selected cases were randomly divided into two groups: the dural hypotonic suture group (experimental group) and the control group (control group). The patients in both groups took appropriate measures of lowering intracranial pressure after operation, and were given nutritional nerve, prevention of epilepsy, parenteral nutrition support, maintenance of electrolyte balance, prevention of falling pneumonia, prevention of stress ulcer and other symptomatic treatment measures. The changes of the disease were confirmed by CT. The general data of the two groups were collected, including preoperative GCS score, operative time and intraoperative bleeding, postoperative antibiotic use time, cerebrospinal fluid leakage, infection, subcutaneous effusion, bone window hernia, epilepsy and so on. The activity of daily living (ADL) was evaluated with the Barthel activity of Daily living (ADL) scale when discharged from hospital. SPSS17.0 software is used to analyze the two groups of data and find out the difference. Results: there was no significant difference in operative time and intraoperative bleeding between the two groups (P0. 05), compared with the incidence of postoperative epilepsy, cerebrospinal fluid leakage, bone window hernia, subcutaneous effusion, etc. The dural tension-reduction suture group was superior to the former group (P0.05), and the group with (ADL): Barthel index score more than 20 points was superior to the non-extensional suture group (P0. 05), and the patients with less than 20% score were superior to those with less than 20 points in the subtraction suture group and the non reduction group (P < 0. 05). There was no significant difference in Zhang group (P 0.05). Conclusion: dural tension-reduction suture can effectively reduce the incidence of intracranial hypertension, postoperative epilepsy, cerebrospinal fluid leakage, infection, subcutaneous effusion and bone window hernia, and can effectively improve the prognosis of patients.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651
本文編號(hào)：2230533
[Abstract]:Objective: to evaluate the advantages and disadvantages of the two operative methods of dural tension-reduction suture and non-tension-free suture by analyzing the intracranial hypertension caused by various common diseases in neurosurgery, and to evaluate the advantages and disadvantages of the two surgical methods, in which the dura mater can not be sutured in situ during craniotomy. To provide a reference for clinical selection of the best operation, further improve the quality of surgery, improve the treatment of patients. Methods: by retrospective analysis, 96 cases of craniotomy and decompression of craniotomy were collected from Neurosurgery Department, affiliated Hospital of Yan'an University, from July 2009 to January 2014. The selected cases were randomly divided into two groups: the dural hypotonic suture group (experimental group) and the control group (control group). The patients in both groups took appropriate measures of lowering intracranial pressure after operation, and were given nutritional nerve, prevention of epilepsy, parenteral nutrition support, maintenance of electrolyte balance, prevention of falling pneumonia, prevention of stress ulcer and other symptomatic treatment measures. The changes of the disease were confirmed by CT. The general data of the two groups were collected, including preoperative GCS score, operative time and intraoperative bleeding, postoperative antibiotic use time, cerebrospinal fluid leakage, infection, subcutaneous effusion, bone window hernia, epilepsy and so on. The activity of daily living (ADL) was evaluated with the Barthel activity of Daily living (ADL) scale when discharged from hospital. SPSS17.0 software is used to analyze the two groups of data and find out the difference. Results: there was no significant difference in operative time and intraoperative bleeding between the two groups (P0. 05), compared with the incidence of postoperative epilepsy, cerebrospinal fluid leakage, bone window hernia, subcutaneous effusion, etc. The dural tension-reduction suture group was superior to the former group (P0.05), and the group with (ADL): Barthel index score more than 20 points was superior to the non-extensional suture group (P0. 05), and the patients with less than 20% score were superior to those with less than 20 points in the subtraction suture group and the non reduction group (P < 0. 05). There was no significant difference in Zhang group (P 0.05). Conclusion: dural tension-reduction suture can effectively reduce the incidence of intracranial hypertension, postoperative epilepsy, cerebrospinal fluid leakage, infection, subcutaneous effusion and bone window hernia, and can effectively improve the prognosis of patients.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 呂立權(quán),江基堯,于明琨,侯立軍,陳志剛,張光霽,朱誠(chéng);Standard large trauma craniotomy for severe traumatic brain injury[J];Chinese Journal of Traumatology;2003年05期
，本文編號(hào)：2230533
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