标准大骨瓣减压术在重型颅脑损伤中的应用

目的：比较标准大骨瓣减压术与常规骨瓣减压术在治疗重症颅脑损伤方面的临床疗效。方法回顾性分析该院于收治的131例重症颅脑损伤患者，随机分为对照组64例，行常规骨瓣减压术治疗；观察组67例采用标准大骨瓣减压术。两组患者性别、年龄及中线结构移位等一般资料比较，差异无统计学意义（P＞O．05），具有可比性，比较两组术前、后颅内压、术后并发症及术后6个月GCS评分方面的差异。结果两组患者术后1、3、5 d颅内压均有所降低，观察组下降更为明显，差异有统计学意义（P＜0.05）；术后并发症比较两组间差异无统计学意义；术后6个月GCS评分观察组优于对照组，差异有统计学意义（P＜0.05）。结论标准大骨瓣减压术治疗重症颅脑损伤可显著降低患者颅内压及死亡率，显著改善预后，适合临床推广。

Application of Standard Large Craniotomy Decompression Surgery in Treatment of Severe Craniocerebral Trauma

Objective To compare the clinical effect of standard large craniotomy decompression surgery and conventional cran-iotomy in the treatment of severe craniocerebral trauma. Methods 131 cases of patients with severe craniocerebral injury admitted in our hospital from January, 2009 to December, 2013 were analyzed retrospectively. The patients were divided into the control group of 64 cases treated by conventional craniotomy, and the observation group of 67 cases treated by standard large craniotomy decompression surgery. There were no statistically significant differences in gender, age and the shift of midline structure between two groups of patients（P〉0.05） with comparability. The intracranial pressure before and after the operation, postoperative complica-tions, and GCS score 6 months after the operation of two groups were compared. Results The intracranial pressure of both groups decreased 1, 3, 5 days after the operation, and that of the observation group decreased more significantly, the difference was statis-tically significant（P〈0.05）;the difference in postoperative complications between the two groups was not statistically significant;the GCS score 6 months after the operation was better than that of the control group, the difference was statistically significant（P〈0.05）. Conclusion Standard large craniotomy decompression surgery in treatment of severe craniocerebral trauma can significantly cut down the intracranial pressure, reduce mortality rate and significantly improve the prognosis of the patients.It deserves to be popu-larized in clinical work.