标准大骨瓣减压术对重型颅脑损伤患者颅内压及预后的影响

目的探讨标准大骨瓣减压术对重型颅脑损伤患者颅内压和预后的影响。方法将我院神经外科2010年1月~2012年1月收治的128例重型颅脑损伤患者分成两组,对照组行常规去骨瓣减压术。观察组行标准大骨瓣减压术,术后第3、5、7天进行腰椎穿刺,监测两组患者的颅内压变化情况、术后的预后及并发症情况。结果标准大骨瓣组术后第3、5、7天的颅内压分别为(20.53±3.64)mmHg、(18.59±2.81)mmHg、(16.34±2.16)mmHg,分别明显低于常规去骨瓣组(P<0.05)。两组术后预后疗效总有效率分别为83.8%、63.3%,标准大骨瓣组术后预后疗效明显优于常规去骨瓣组(χ2=5.749,P<0.05)。标准大骨瓣组术后并发症发生率19.1%(13/68),常规去骨瓣组术后并发症发生率36.7%,两组并发症发生率比较,差异具有统计学意义(P<0.05)。结论与常规去骨瓣减压术相比,标准大骨瓣减压术治疗重型颅脑损伤疗效确切,可以明显降低颅内压,改善患者的预后且并发症少,值得推广和应用。

Effects of standard decompressive craniectomy on intracranial pressure and prognosis for patients with severe head injury

Objective To investigate the effect of standard hemicraniectomy on intracranial pressure and prognosis for patients with severe head injury. Methods One hundred and twenty-eight cases patients were randomly divided into two groups,the control group underwent conventional decompressive craniectomy. Observation group underwent stan- dard hemicraniectomy,after 3,5,7 days the first lumbar puncture,intracranial pressure were monitored. The postopera- tive prognosis, postoperative complications were compared between two groups. Results The standard large trauma group after the first 3,5,7 days intracranial pressure was （20.53±3.64） mmHg, 18.59±2.81 mmHg, 16.34±2.16 mmHg, respectively, was significantly lower than the conventional cranieetomy group （P〈0.05）. Postoperative prognosis total ef- fective rate were 83.8% ,63.3% and the standard large trauma postoperative prognosis was significantly better than con- ventional cranieetomy group （P〈0.05）. Standard large trauma postoperative complication rate of 19.1% （13/68）, was less than the conventional craniectomy group complication rate of 36.7% （P〈0.05）. Conclusion Compared with con- ventional decompressive eraniectomy,the standard hemicraniectomy curative treatment of severe traumatic brain injury can significantly reduce the intracranial pressure,improve patient outcomes and fewer complications, worthy of promo- tion and application.