阶梯减压下去骨瓣减压术对重度颅脑损伤患者术后转归的影响

目的探讨阶梯减压下去骨瓣减压术对重度颅脑损伤（sTBI）患者术后转归的影响。 方法将吉林大学第一医院二部神经外科自2014年11月至2015年12月收治的行去骨瓣减压术的sTBI患者68例采用随机数字表法分为观察组和对照组各34例。观察组术中全程监测颅内压，采用阶梯减压的方法；对照组行标准外伤大骨瓣减压术。术后1个月采用Baethel指数（BI）评估日常生活能力，采用肢体运动功能运动量表（FM）评估肢体运动功能，比较手术并发症发生率，术后6个月采用GOS评分评估患者近期预后。 结果观察组的恢复良好率（41.18%）明显高于对照组（17.64%），差异具有统计学意义（P<0.05）；观察组术后1个月BI评分、FM评分（78.37±8.96、83.67±14.72）高于对照组（65.24±7.91、72.33±13.68），差异具有统计学意义（P<0.05）；观察组急性脑膨出发生率（5.89%）低于对照组（23.53%），差异具有统计学意义（P<0.05）；术后迟发性颅内血肿、大面积脑梗的几率（8.82%、5.89%）略低于对照组（26.47%、11.76%），差异无统计学意义（P>0.05）。 结论阶梯减压下去骨瓣减压术可降低sTBI患者急性脑膨出发生率，改善近期预后。

Effect of decompressive craniectomy under stepped decompression on the outcome of patients with severe traumatic brain injury

ObjectiveTo investigate the effect of decompressive craniectomy under stepped decompression on the outcome of patients with severe traumatic brain injury. MethodsA total of 68 patients with severe craniocerebral injury undergoing elective decompressive craniectomy in the hospital were randomly divided into the observation group and the control group by random number table method, 34 cases in each group. Stepped decompression was used for monitoring intracranial pressure of the observation group during operation while the control group were treated by standard decompressive craniectomy. Six months after the operation, the short-term prognosis, activities of daily living and limb movement function were evaluated with the GOS, Baethel index (BI) and Fugl-Meyer assessment (FM). The incidence of complications was compared. ResultsThe excellent and good rate of recovery was significantly higher in the observation group than the control group (41.18% vs. 17.64%) (P<0.05). One months after operation, BI score and FM score were higher in observation group (78.37±8.96, 83.67±14.72) than the control group (65.24±7.91, 72.33±13.68) (P<0.05). The incidence of acute encephalocele was lower in observation group than the control group (5.89% vs. 23.53%) (P<0.05), while the incidence of delayed intracranial hematoma and postoperative large-area cerebral infarction were slightly lower than the control group (8.82% vs. 26.47%, 5.89% vs. 11.76%) (P>0.05). ConclusionDecompressive craniectomy under stepped decompression can reduce the incidence of acute encephalocele and improve the prognosis of patients with severe craniocerebral injury.