创伤控制理论在特重型颅脑损伤双侧开颅手术中的应用

目的 探讨和评价创伤控制理论在特重型颅脑损伤患者双侧开颅手术中的应用价值.方法 将符合标准的70例格拉斯哥昏迷量表评分≤5分的特重型颅脑损伤患者按随机数字表法分为标准外伤开颅组（常规组）,非标准骨瓣开颅及小硬脑膜窗策略组（改良组）,每组35例,比较其临床资料.结果 与常规组比较,改良组在术后骨窗脑组织嵌顿、大面积脑梗死发生率方面差异无统计学意义（P＞0.05）;而在手术持续时间、术后24 h内输血量、术后1个月内创伤性癫痫发作、术中急性脑膨出方面差异有统计学意义[（2.80 ±0.63）h比（4.21±1.04）h、（3.90±1.02）U比（5.55±1.32）U、14.3％（5/35）比48.6％（17/35）、5.7％（2/35）比25.7％（9/35）]（P＜0.05）.随访半年,常规组预后良好4例,中残4例,重残8例,植物生存6例,死亡13例;改良组预后良好8例,中残9例,重残5例,植物生存4例,死亡9例.两组预后疗效比较差异有统计学意义（x2=5.040,P=0.025）.结论 特重型颅脑损伤双侧开颅损伤较大,应用创伤控制理论指导的改良手术方式,可提高抢救效率.

Application of damage control theory in bilateral craniotomy operation of severe craniocerebral trauma

Objective To explore and evaluate the application value of damage control theory in bilateral craniotomy operation of severe craniocerebral trauma.Methods Seventy patients with Glasgow coma scale score ≤ 5 scores were divided into 2 groups by random digits table method with 35 cases each：standard trauma craniotomy group （normal group）,non-standard craniotomy and small dural window exposure strategy group （improved group）.The clinical data were compared.Results There was no significant difference in postoperative cerebral tissue bone window embedded meal,large area cerebral infarction incidence rate between two groups （P ＞ 0.05）.There was significant difference in the duration of surgery,blood transfusion amount within 24 hours,traumatic epileptic seizure within 1 month,the acute intraoperative encephalocele between normal group and improved group [（2.80 ± 0.63） h vs.（4.21 ± 1.04） h,（3.90 ± 1.02） U vs.（5.55 ± 1.32）U,14.3％（5/35） vs.48.6％（17/35）,5.7％（2/35） vs.25.7％（9/35）] （P ＜0.05）.Followed up for 6 months,good prognosis,moderate disability,severe disability,vegetative state,death was 4,4,8,6,13 cases in normal group and 8,9,5,4,9 cases in improved group,and there was significant difference （x2 =5.040,P =0.025）.Conclusion Severe craniocerebral trauma bilateral craniotomy damage is bigger,damage control theory to guide the improved operation method,can improve the rescue efficiency.