应急状态下早期去骨瓣减压治疗重型颅脑损伤时间窗的初步研究

目的探讨模拟应急状态下野战医院实施早期去骨瓣减压术（EDC）的可行性和可靠性。 方法单中心回顾性队列研究解放军第九六〇医院神经外科自2016年1月至2019年9月收治的40例重型颅脑损伤（sTBI）患者,按照手术时机的不同将患者分为EDC组和去骨瓣减压术（DC）组,比较2组患者的手术时间窗、术中输血量、伤后24 h内脑挫裂伤进展性发展形成血肿、术后出现脑疝时间窗、术后达到安全后送的生命体征稳定时间窗等指标。 结果EDC组的手术时长短于DC组,术中输血量少于DC组,24 h内进展性脑挫裂、脑疝发生率小于DC组,脑疝发生时间窗长于DC组,差异均有统计学意义（P<0.05）。2组患者的术后生命体征稳定时间比较,差异无统计学意义（P>0.05）。 结论EDC是应急状态下野战医疗所治疗sTBI有效的手术方式。

Preliminary study on the time window of early decompressive craniectomy in the treatment of severe traumatic brain injury

ObjectiveTo investigate the feasibility and reliability of early decompressive craniectomy (EDC) in field hospitals under simulated emergency state. MethodsA single center retrospective cohort study was conducted in 40 patients with severe and extremely severe traumatic brain injury (sTBI) admitted to the Neurosurgery Department of the 960^th Hospital of Chinese PLA from January 2016 to September 2019. They were divided into EDC group and decompressive craniectomy (DC) group according to the operation time. The operation time window, the amount of intraoperative blood transfusion, brain contusion and laceration progressed to form a hematoma within 24 h after injury, the time window of postoperative cerebral hernia and the stable time window of vital signs after safe evacuation were compared between the two groups. ResultsThe operation time of EDC group was shorter than that of DC group, the amount of intraoperative blood transfusion was less than that of DC group, the incidence of progressive cerebral contusion and cerebral hernia within 24 h was less than that of DC group, and the time window of cerebral hernia was longer than that of DC group (P<0.05). There was no significant difference in the stability time of postoperative vital signs between the two groups (P>0.05). ConclusionEDC is an effective surgical method for sTBI in field medical station under emergency state.