CAJ | 학술논문

目的分析超低位大骨瓣开颅颞肌下减压术治疗创伤性脑疝的疗效.方法将颅脑创伤性脑疝53例,分为单瞳孔散大组22例,双瞳孔散大组31例,两组患者均采用超低位大骨瓣开颅颞肌下减压术.术后密切观察并记录两组患者的颅内压(ICP)、环池显示率、瞳孔回缩率和GCS评分,其结果用t检验分析.结果颅内压监护:两组患者术后24 h ICP＜20 mm Hg的病例比例显著增高,72 h＞40 mm Hg比例显著降低;脑池显示率:术后48 h单瞳散大组81.82%,双瞳散大组51.61%;瞳孔恢复率:24 h瞳孔恢复正常,单瞳散大组77.27%,双瞳散大组32.26%;GCS评分:全组术后GCS评分平均(8.02±3.03)分,比术前(4.10±0.82)分提升(3.92±2.21)分,手术前后比较差异有统计学意义(P＜0.01);治疗结果:良好/中残64.15%,重残/长期昏迷7.55%,死亡28.30%.结论超低位大骨瓣开颅颞肌下减压术,能有效扩增颅腔容积,增加侧后方的减压空间,具有缓冲脑干中轴部位的颅内压作用.
목적 분석초저위대골판개로섭기하감압술치료창상성뇌산적료효.방법 장로뇌창상성뇌산53례,분위단동공산대조22례,쌍동공산대조31례,량조환자균채용초저위대골판개로섭기하감압술.술후밀절관찰병기록량조환자적로내압(ICP)、배지현시솔、동공회축솔화GCS평분,기결과용t검험분석.결과 로내압감호:량조환자술후24 h ICP＜20 mm Hg적병례비례현저증고,72 h＞40 mm Hg비례현저강저;뇌지현시솔:술후48 h단동산대조81.82%,쌍동산대조51.61%;동공회복솔:24 h동공회복정상,단동산대조77.27%,쌍동산대조32.26%;GCS평분:전조술후GCS평분평균(8.02±3.03)분,비술전(4.10±0.82)분제승(3.92±2.21)분,수술전후비교차이유통계학의의(P＜0.01);치료결과:량호/중잔64.15%,중잔/장기혼미7.55%,사망28.30%.결론 초저위대골판개로섭기하감압술,능유효확증로강용적,증가측후방적감압공간,구유완충뇌간중축부위적로내압작용.
Objective To investigate the treatment effection of cranial decompression under temporal muscle in very-low position with large bone flap for severe cranial trauma.Methods 53 cases of severs cranial traumatic brain herniation were derided into two groups.22 cases with unilateral dilated pupil,and 31 cases of bilateral dilated pupil,all the patients were treated with cranial decompression under temporal muscle in very low position with large bone-flap.The ICP,appearance rate of cisternal,pupil contraction rate and GCS evaluation were observed,recorded and statistiely analysised.Results According to the intraeranial pressure monitoring,the rate of 24h ICP＜20mmHg was increased significantly,and the rate of 72h ICP＞40mmHg was decreased in both groups.The occurance rate of cisternal:81.82% in unilateral dilated pupil group,and 51.61% in bilateral dilated pupil group.The recoverance rate of pupil in 24h:77.2% in unilateral dilated pupil group,and 32.26% in bilateral dilated pupil group.GCS evaluation:All of the patient's average mark of GCS after operation wag(8.02±3.03)which increased(3.92±2.21)compared with the mark of GCS before operation,which was(4.10±0.82),with a significant difference(P＜0.01).Treat outcome:well/moderate disability:64.15%,severe/long-term coma:7.55%,and death:28.30%.Conclusion Cranial decompression under temporal muscle in very-low position with large bone-flap for severe cranial trauma can enlarge the cranial capacity effectively,increase the decompression space in dorsolateral cranium,which can alleviate the intracranial pressure in axial centre of brain truak,promote the effeetion of the brain herniation restore and the recover of the brain trauma.