标准大骨瓣减压术联合选择性脑局部亚低温对重型颅脑损伤的疗效分析

目的探讨标准大骨瓣减压术联合选择性脑局部亚低温对重型颅脑损伤的治疗效果。方法回顾性分析2000年1月至2007年12月91例在本院神经外科住院的重型颅脑损伤的患者，均行标准大骨瓣减压术，根据术后有无行选择性脑局部亚低温治疗分为A、B两组，比较术后颅内压的变化及治疗预后。结果两组术后颅内压均在同一水平，在行亚低温治疗后，A组在术后24小时、48小时、72小时颅内压明显较治疗前降低，B组在术后48小时、72小时颅内压明显较治疗前降低，差异有统计学意义（P〈0．05）；A组在术后24小时、72小时的颅内压明显低于B组，差异有统计学意义（P〈O．05）。A组治疗有效率为42．9％，明显高于对照组21．4％，差异有统计学意义（P〈O．05）。结论标准大骨瓣减压术是救治重型颅脑损伤的患者有效的方式，术后给予脑局部亚低温能显著降低颅内压，改善患者预后。

The clinical effects of selective hypothermia and decompressive craniectomy on severe traumatic brain injury

Objective To investigate the clinical effects of selective hypothermia and decompressive cranieetomy on severe traumatic brain injury （sTBI）. Methods 91 patients with sTBI were divided into 2 groups by accepting selective hypothermia or not （group A and group B）. The mean intracranial pressure （ICP） and prognosis of treatment were observed after deeompressive eraniectomy. Results The ICP of group A was decreased significantly after 24h, 48h and 72h of postorperation （P〈0.05）. The ICP of group B was decreased significantly after 48h and 72h of postorperation（P〈0.05）. Selective hypothermia could decreased ICP significantly after operation. The effective rate of group A was higher than that of group B （P〈0.05）. Conclusion Selective hypothermia and deeornpressive cranieetomy in sTBI are a safe and effective method, which can reduce ICP and improve prognosis.