223例标准大骨瓣开颅手术临床分析

目的]探讨分析大骨瓣减压术治疗重型颅脑损伤中的临床预后及影响因素.方法]回顾性分析本院采用大骨瓣减压术治疗的223例重型颅脑损伤患者资料分析影响患者预后的因素.结果]根据格拉斯哥预后评分（GOS）,恢复良好（GOS 5分）62例,中残（GOS 4分）53例,重残（GOS 3分）32例,植物生存（GOS 2分）12例,死亡（GOS 1分）64例.Logistic 回归分析表明GCS评分、年龄、脑疝与否及手术减压时间是影响重型颅脑损伤预后的独立因素.伤后1.5 h内完成手术减压者预后明显优于其他患者.31例（13.9%）发生迟发性颅内血肿,其中硬膜外血肿占74.2%（23例）.结论]重型颅脑损伤死残率高,标准大骨瓣减压术效果确切,手术减压时间是唯一可控制的影响手术预后的因素,发病后1.5 h内手术减压疗效最佳.

Clinical Analysis of Standard Large Decompressive Craniectomy in 223 Cases

Objective] To explore the clinical prognosis and influential factors of the standard large decompressive craniectomy in severe traumatic brain injury. ：Methods] The clinical data of 223 cases of severe traumatic brain injury undergoing standard large decompressive craniectomy were studied retrospectively. The influential factors of the prognosis of the patients were analyzed. Results]Among the 223 cases, 62 cases had good recovery（GOS= 5）, and 53 cases were moderate disability（GOS=4）, and 32 cases were severe disability （GOS= 3）, and 12 cases were vegetative state（GOS= 2） and 63 cases died（GOS= 1）. Logistic regression a- nalysis showed that GCS score, age, brain hernia and decompressive time were the independent influential factors of the prognosis of severe traumatic brain injury. The prognosis of the patients completing the operation within 1.5h after trauma was obviously superior to the other patients. The delayed intracranial hematoma occurred in 32 cases（13.9%）, in which 23 cases（74.2%） were epidural hematomas. Conclusion] The disability and death rate of severe traumatic brain injury is high. Standard large decompressive craniectomy has definite effect. Decompressive time is the only one controllable factor influencing the prognosis of the surgery. The surgical decompression within 1.5h after onset is most effective.