重型颅脑损伤急行双侧去大骨瓣减压术后立即应用尼莫地平的临床疗效观察

目的：讨论重型颅脑损伤急行双侧去大骨瓣减压术后立即使用尼莫地平治疗与常规治疗的疗效差异。方法：将84例重型颅脑损伤患者随机分为观察组和对照组各42例。对照组急行双侧去大骨瓣减压术，并采取常规治疗。观察组在急行双侧去大骨瓣减压术后立即使用尼莫地平。随访6个月，记录出院1个月后的GCS评分和清醒患者的MMES评分以及6个月后清醒患者的MMES评分，以比较疗效。结果：观察组和对照组术前和出院1个月的GCS评分差异分别为（2.36±0.77）分和（2.33±0.73）分，两组治疗前后的GCS评分组内比较差异有统计学意义（P＜0.05）。但两组患者治疗前后的GCS评分组间比较差异无统计学意义（P＞0.05）。观察组和对照组术后1个月各有27例（64.29%）和16例（38.10%）患者清醒，两组清醒率比较差异有统计学意义（P＜0.05）。观察组术前、出院1个月和出院6个月的MMES评分分别为（10.7±6.26）分、（18.9±7.21）分、（21.4±7.27）分，对照组术前、出院1个月和出院6个月的MMES评分分别为（10.9±6.32）分、（13.8±6.52）分、（15.8±5.79）分，两组出院1个月和出院6个月的MMES评分与术前相比，差异均有统计学意义（P＜0.05）。两组出院1个月和出院6个月MMES评分组间比较差异有统计学意义（P＜0.05）。结论：重型颅脑损伤急行双侧去大骨瓣减压术后立即使用尼莫地平，可以提升治疗效果，改善患者精神状态，促进清醒，在临床中具有较高的运用价值。

The Clinical Efficacy of Nimodipine Applied Immediately after Bilateral Hemicraniectomy in Treatment of Acute Severe Head Injury

Objective：To discuss differences of efficacy of nimodipine therapy and conventional treatment used immediately after bilateral hemicraniectomy in treatment of severe head injury. Method：84 patients were randomly divided into observation group and control group of 42 cases. Emergency control group underwent bilateral hemicraniectomy and regular treatment.Acute observation group were treated with nimodipine immediately after bilateral hemicraniectomy. Followed for 6 months,GCS score of all patients after a month,MMES score of sober patients after a month and six months were recorded and compared. Result：The differences of GCS score before and after treatment in the observation group and control group were（2.36±0.77）＆amp;nbsp;and（2.33±0.73）. GCS had significantly different before and after treatment in each group（P〈0.05）. However,comparisons,GCS were no significant difference before and after treatment between two groups（P〈0.05）.Awake patients were 27 cases（64.29%）and 16 cases（38.10%）in o bservation group and control group after one month,awake rate were significantly different between the two groups（P〈0.05）. MMES scores of observation group in preoperative,a month,and six months after discharge were（10.7±6.26）,（18.9±7.21）,（21.4±7.27）. MMES scores of control group in preoperative, a month,and six months after discharge were（10.9±6.32）,（13.8±6.52）,（15.8±5.79）. Compared with preoperative,MMES score in discharged one month and six months had significant difference in each group（P〈0.05）.MMES score in discharged one month and six months had significantly different between the two groups（P〈0.05）. Conclusion：Nimodipine therapy used immediately after bilateral hemicraniectomy in treatment of acute severe head injury,can enhance the therapeutic effect,improve the mental state of the patient,promote sobriety,it has high value in clinical use.