腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者并发症和预后的影响

目的探讨腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者并发症和预后的影响,以期为优化该类患者外科治疗提供参考性依据。方法选取2013年2月~2016年4月我院收治的重型颅脑损伤患者184例,按数字随机表法分为试验组和对照组,各92例,对照组患者采取骨瓣减压控制术治疗,试验组患者则在对照组患者的基础上联合腰大池持续引流术治疗,分别于术后3d、5d、7d检测患者颅内压(ICP),于术后6个月时采格拉斯哥预后评分(GPS)评估两组患者预后情况,详细记录两组患者脑水肿、脑梗死等术后并发症发生情况,并进行组间比较。结果试验组患者术后3d、5d、7d ICP值均明显低于对照组患者,差异具有统计学意义(P0.05);术后3d、5d、7d时试验组患者GCS评分均明显高于对照组患者,差异均具有统计学意义(P0.05);与对照组患者比较,试验组患者术后脑水肿发生率明显降低,脑水肿程度也明显减轻,差异均具有统计学意义(P0.05);与对照组患者比较,试验组患者术后脑梗死发生率明显降低,且梗死体积也明显缩小,差异均具有统计学意义(P0.05);术后6个月时,试验组患者预后良好率、预后不良率和死亡率分别为59.78%(55/92)、33.70%(31/92)、6.52%(6/92),对照组患者分别为39.13%(36/92)、50.00%(46/92)、10.87%(10/92),两组患者术后预后情况差异具有统计学意义(P0.05)。结论腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者的疗效显著,可有效降低ICP,改善预后,降低术后并发症的发生,效果优于仅采用骨瓣减压控制术。

Effect of continuous lumbar drainage combined with decompressive craniectomy on complications and prognosis of patients with severe craniocerebral injury

Objective To investigate the effect of continuous lumbar drainage combined with decompressive craniectomy on the complications and prognosis of patients with severe craniocerebral injury,and to provide a reference for optimization of surgical treatment in such patients.Methods A total of 184 patients with severe craniocerebral injury who were admitted to our hospital from February 2013 to April 2016 were enrolled and randomly divided into experimental group and control group using a random number table,with 92 patients in each group.The patients in the control group were given decompressive craniectomy,and those in the experimental group were given continuous lumbar drainage in addition to the treatment in the control group.Intracranial pressure (ICP) was measure at 3,5,and 7 days after surgery,and the Glasgow Prognosis Scale (GPS) score was used to evaluate prognosis at 6 months after surgery.The incidence of postoperative complications such as cerebral edema and cerebral infarction was recorded in detail and compared between the two groups.Results At 3,5,and 7 days after surgery,the experimental group had significantly lower ICP and a significantly higher GCS score than the control group (P ＜ 0.05).Compared with the control group,the experimental group had significant reductions in the incidence rate of cerebral edema after surgery and the degree of cerebral edema (P ＜ 0.05).The experimental group had significant reductions in the incidence rate of cerebral infarction after surgery and infarct volume compared with the control group (P ＜0.05).At 6 months after surgery,the experimental group had a good prognosis rate of 59.78％ (55/92),a poor prognosis rate of 33.70％ (31/92),and a death rate of 6.52％ (6/92),and the control group had a good prognosis rate of 39.13％ (36/92),a poor prognosis rate of 50.00％ (46/92),and a death rate of 10.87％ (10/92);there was a significant difference in prognosis between the two groups (P ＜ 0.05).Conclusions Continuous lumbar drainage combined with decompressive craniectomy has a marked effect in the treatment of patients with severe craniocerebral injury and can effectively reduce ICP,improve prognosis,and reduce the incidence of postoperative complications.Therefore,it has a better effect than deeompressive craniectomy alone.