对冲性颅脑损伤常规或标准大骨瓣减压术中急性脑膨出的发生情况及预后比较

目的: 比较常规及标准大骨瓣减压术治疗对冲性颅脑损伤患者术中急性脑膨出及预后的影响。方法: 选择100例对冲性颅脑损伤患者，按手术方式分为常规组(n=44，常规大骨瓣减压术)与标准组(n=56，标准外伤大骨瓣减压术)，统计两组术中急性脑膨出及术后并发症发生率，比较两组双侧血肿厚度及中线移位程度，记录两组手术前后不同时间颅内压、格拉斯哥昏迷评分(GCS)的变化，比较术后3个月两组格拉斯哥预后评分(GOS)。结果： 标准组术中急性脑膨出、切口疝、迟发型血肿发生率均明显低于常规组(P均<0.05)；与术前相比，术后两组对侧血肿厚度明显降低，中线移位明显减少(P<0.05)；标准组对侧血肿厚度及中线移位均明显低于常规组(P<0.05)；与术前相比，术后1、3、7 d两组颅内压均明显降低、GCS评分均明显上升(P<0.05)；标准组术后不同时间颅内压及GCS评分均明显高于常规组(P均<0.05)；标准组GOS评分中轻度残疾例数高于常规组，死亡例数低于常规组(P<0.05)。 结论： 对冲性颅脑损伤患者行标准大骨瓣减压术可有效降低患者颅内压，减轻血肿及中线移位程度，预防术中急性脑膨出，减少术后并发症发生风险，有助于改善其预后。

Comparison of the incidence of acute encephalocele and prognosis in patients with bump brain injury treated by conventional or standard decompressive craniectomy

Objective: To compare the effect of conventional and standard decompressive craniectomy on acute encephalocele and the prognosis of patients with bump brain injury. Methods: A total of 100 patients with bump brain injury were divided into conventional group(n=44, conventional decompressive craniectomy) and standard group(n=56, standard decompressive craniotomy). The incidence of acute encephalocele during operation and complications after operation was analyzed, and the changes in bilateral hematoma and the degree of midline shift were compared between the two groups. The changes of intracranial pressure and the Glasgow Coma Scale(GCS) scores at different time before and after operation were recorded, and the Glasgow Outcome Scale(GOS) scores were compared between the two groups at 3 months after operation. Results: The incidence rates of acute encephalocele, incisional hernia and delayed hematoma in the standard group were lower than those in the conventional group(P<0.05). After operation, the thickness of contralateral hematoma decreased and the midline shift decreased in the two groups. The thickness of the contralateral hematoma and the midline shift in the standard group were lower than those in the conventional group(P<0.05). Compared with pre operation, the intracranial pressure were decreased and GCS scores were increased in the two groups at 1 d, 3 d and 7 d after operation, and changes in the standard group at different time after operation were greater than those in the control group(P<0.05). The proportion of mild to moderate disability evaluated by GOS score in the standard group was higher than that in the conventional group, and the proportion of death was lower than that in the conventional group(P<0.05). Conclusion: The treatment with standard decompressive craniectomy for patients with bump brain injury could effectively reduce intracranial pressure, hematoma and the degree of midline shift, prevent acute encephalocele during operation, and reduce the risk of complications after operation. Finally, the prognosis could be improved.