标准大骨瓣减压治疗重型颅脑损伤疗效分析

目的探讨标准大骨瓣减压治疗重型颅脑损伤的效果。方法107例重型颅脑损伤病人（GCS≤8）,分别采用标准大骨瓣减压（n=57）和常规骨瓣减压（n=50）,比较术后颅内压及术后6个月GOS评分。结果术后第1 d、3 d、7 d标准大骨瓣组颅内压分别为（22.3±3.2）mmHg,（19.6±2.4）mmHg及（16.1±2.1）mmHg,常规骨瓣组分别为（30.1±3.5）mmHg,（28.5±2.4）mmHg,（24.4±2.9）mmHg,组间比较有显著差异（P〈0.01）。两组均获随访,术后6个月疗效按GOS评分判断：标准大骨瓣组良好22例,中残17例,重残8例,植物生存6例,死亡4例;常规骨瓣组良好12例,中残10例,重残12例,植物生存8例,死亡8例,标准大骨瓣组良好率为38.6%,显著高于常规骨瓣组的24.0%（P〈0.01）。结论标准大骨瓣减压治疗重型颅脑损伤能有效降低颅内压,改善预后。

Effect Analysis of Standard Large Trauma Craniotomy in Severe Craniocerebral Injury

Objective To investigate the decompression effect of standard large trauma craniotomy（SLTC） in treating severe craniocerebral injury.Methods 107 severe craniocerebral injury cases with GCS score ≤8 were underwent decompression by SLTC in 57 cases（standard group） and routine craniotomy in 50 cases（routine group）.The intracranial pressure（ICP） and 6-month GOS score was compared between the two groups.Results The ICP of 1-,3-,and 7-day after operation was（22.3±3.2）mmHg,（19.6±2.4）mmHg and（16.1±2.1）mmHg in the standard group,and（30.1±3.5）mmHg,（28.5±2.4）mmHg and（24.4±2.9）mmHg in the route group.There was remarkable difference between the two groups （P〈0.01）.All cases were followed up.The results were evaluate by GOS 6 months after operation.The outcome showed 22 of good recovery,17 of moderate disability,8 of severe disability,6 of persistent vegetative status,and 4 of death in the standard group,and 12 of good recovery,10 of moderate disability,12 of severe disability,8 of persistent vegetative status,and 8 of death in the route group.The favorable outcome of standard group was 38.6%,and obviously higher than 24.0% of route group（P〈0.01）.Conclusion The decompression method of SLTC can decrease the ICP and improve the prognosis efficiently for severe craniocerebral injury.