颅内压监测下改良阶梯减压法结合去骨瓣减压治疗颅内高压的疗效分析

目的探讨颅内压（ICP）监测下改良阶梯减压法结合去骨瓣减压术治疗颅内高压的临床疗效。 方法回顾性分析贵阳市第二人民医院神经外科自2017年1月至2020年6月收治的312例各种病因导致颅内高压需行开颅去骨瓣减压术治疗患者的临床资料，根据患者术中是否采用改良阶梯减压术，将患者分为改良阶梯减压结合去骨瓣减压术组（改良组）和常规开颅去骨瓣减压术组（常规组），所有患者均在术中实时监测ICP，对比观察2组患者的术中ICP变化、术后并发症及预后情况。 结果312例患者中，常规组154例，改良组158例，常规组术中剪开硬脑膜后ICP值急剧下降后反弹升高并趋于稳定，改良组术中ICP平缓下降后趋于稳定。2组患者的术中脑肿胀、脑膨出、迟发对侧血肿、术后GCS评分、瞳孔变化、并发症、术后6个月的GOS评分比较，差异均具有统计学意义（P<0.05）。 结论ICP监测下改良阶梯减压法处理高颅压患者能有效控制ICP、减免术中脑膨出、减少迟发血肿形成，是一种安全、有效、可行的去骨瓣减压方法。

Clinical analysis of modified stepwise decompression technique combined with decompressive craniectomy under intracranial pressure monitoring to treat high intracranial pressure

ObjectiveTo explore the clinical effect of modified stepwise decompression technique combined with decompressive craniectomy under intracranial pressure monitoring in the treatment of high intracranial pressure. MethodsA retrospective case-control study was used to analyze the clinical data of 312 patients with intracranial hypertension caused by various causes who needed decompressive craniotomy admitted to Neurosurgery Department of the Second People's Hospital of Guiyang from January 2017 to June 2020. The patients were divided into modified stepwise decompression combined with decompressive craniectomy group (improved group) and conventional decompressive craniotomy group (conventional group). All patients received real-time intracranial pressure monitoring during the operation. The changes of intraoperative intracranial pressure, postoperative complications and prognosis of the two groups were compared and analyzed. ResultsIn the conventional group, intracranial pressure decreased sharply, rebounded and became stable after cutting the dura mater. In the modified group, intracranial pressure decreased gradually and stabilized. There were significant differences in intraoperative brain swelling, encephalocele, delayed contralateral hematoma, postoperative GCS score, pupil changes, complications and GOS score 6 months after operation between the two groups (P<0.05). ConclusionModified stepwise decompression technique combined with decompressive craniectomy can effectively control intracranial pressure, reduce intraoperative encephalocele, and reduce the formation of delayed hematoma. It is a safe, effective and feasible method for decompressive craniectomy.