中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
17期
4-7
,共4页
颅脑损伤%脑膜膨出%预后
顱腦損傷%腦膜膨齣%預後
로뇌손상%뇌막팽출%예후
Craniocerebral trauma%Meningocele%Prognosis
目的 探讨双侧去骨瓣减压开颅术治疗双侧对冲性重型颅脑损伤(DHSCBI)的临床效果.方法 将60例DHSCBI患者按照随机数字表法分为治疗组和对照组,每组30例.治疗组给予双侧去骨瓣减压开颅术治疗,对照组给予标准单侧外伤大骨瓣减压窗手术治疗.观察两组急性脑膨出和切口疝发生情况,记录术后1、3、7d颅内压情况,术后随访3个月评价临床疗效.结果 治疗组急性脑膨出和切口疝发生率分别为13.3％(4/30)和20.0％(6/30),均显著低于对照组的56.7％(17/30)、63.3％ (19/30),两组比较差异有统计学意义(P＜0.01)；治疗组术后1、3、7d颅内压[(21.34±3.05)、(18.43±2.63)、(15.52±2.21) mm Hg(1 mm Hg=0.133 kPa)]显著低于对照组[(31.21±4.46)、(29.13±4.16)、(24.97±3.57) mm Hg](P＜ 0.05);治疗组临床疗效有效率为53.3％(16/30),显著高于对照组的23.3％( 7/30)(P＜0.05)；治疗组病死率为16.7％(5/30),显著低于对照组的40.0％(12/30) (P＜ 0.05).结论 双侧去骨瓣减压开颅术治疗DHSCBI明显优于标准单侧外伤大骨瓣减压窗手术,可以减少急性脑膨出和切口疝的发生,患者预后良好,值得临床应用.
目的 探討雙側去骨瓣減壓開顱術治療雙側對遲性重型顱腦損傷(DHSCBI)的臨床效果.方法 將60例DHSCBI患者按照隨機數字錶法分為治療組和對照組,每組30例.治療組給予雙側去骨瓣減壓開顱術治療,對照組給予標準單側外傷大骨瓣減壓窗手術治療.觀察兩組急性腦膨齣和切口疝髮生情況,記錄術後1、3、7d顱內壓情況,術後隨訪3箇月評價臨床療效.結果 治療組急性腦膨齣和切口疝髮生率分彆為13.3％(4/30)和20.0％(6/30),均顯著低于對照組的56.7％(17/30)、63.3％ (19/30),兩組比較差異有統計學意義(P＜0.01)；治療組術後1、3、7d顱內壓[(21.34±3.05)、(18.43±2.63)、(15.52±2.21) mm Hg(1 mm Hg=0.133 kPa)]顯著低于對照組[(31.21±4.46)、(29.13±4.16)、(24.97±3.57) mm Hg](P＜ 0.05);治療組臨床療效有效率為53.3％(16/30),顯著高于對照組的23.3％( 7/30)(P＜0.05)；治療組病死率為16.7％(5/30),顯著低于對照組的40.0％(12/30) (P＜ 0.05).結論 雙側去骨瓣減壓開顱術治療DHSCBI明顯優于標準單側外傷大骨瓣減壓窗手術,可以減少急性腦膨齣和切口疝的髮生,患者預後良好,值得臨床應用.
목적 탐토쌍측거골판감압개로술치료쌍측대충성중형로뇌손상(DHSCBI)적림상효과.방법 장60례DHSCBI환자안조수궤수자표법분위치료조화대조조,매조30례.치료조급여쌍측거골판감압개로술치료,대조조급여표준단측외상대골판감압창수술치료.관찰량조급성뇌팽출화절구산발생정황,기록술후1、3、7d로내압정황,술후수방3개월평개림상료효.결과 치료조급성뇌팽출화절구산발생솔분별위13.3％(4/30)화20.0％(6/30),균현저저우대조조적56.7％(17/30)、63.3％ (19/30),량조비교차이유통계학의의(P＜0.01)；치료조술후1、3、7d로내압[(21.34±3.05)、(18.43±2.63)、(15.52±2.21) mm Hg(1 mm Hg=0.133 kPa)]현저저우대조조[(31.21±4.46)、(29.13±4.16)、(24.97±3.57) mm Hg](P＜ 0.05);치료조림상료효유효솔위53.3％(16/30),현저고우대조조적23.3％( 7/30)(P＜0.05)；치료조병사솔위16.7％(5/30),현저저우대조조적40.0％(12/30) (P＜ 0.05).결론 쌍측거골판감압개로술치료DHSCBI명현우우표준단측외상대골판감압창수술,가이감소급성뇌팽출화절구산적발생,환자예후량호,치득림상응용.
Objective To investigate the clinical efficacy of bilateral decompressive craniotomy for treating the patients with double hedge severe craniocerebral injury (DHSCBI).Methods Sixty patients with DHSCBI were divided by random digits table method into treatment group and control group with 30 cases each.The treatment group was treated with bilateral decompressive craniotomy,while the control group was treated with traditional unilateral craniotomy.The acute brain swelling,incisional hernia,intracranial pressure of postoperative 1,3,7 d were observed and recorded.The patients were followed up for 3 months to evaluate the clinical efficacy.Results The incidence of acute brain swelling and incisional hernia in treatment group were 13.3％ (4/30) and 20.0％ (6/30),respectively,which were significantly lower than those in control group [56.7％ (17/30) and 63.3％ (19/30)] (P ＜0.01 ).The intracranial pressure of postoperative 1,3,7 d in treatment group [(21.34 ±3.05),(18.43 ±2.63),(15.52 ±2.21) mm Hg(1mm Hg =0.133 kPa)] were significantly lower than those in control group[ (31.21 ± 4.46),(29.13 ±4.16),(24.97 ±3.57) mm Hg] (P ＜0.05).The clinical efficacy in treatment group [53.3％ (16/30)] was significantly higher than that in control group [23.3％ (7/30)] (P ＜ 0.05 ).The mortality rate in treatment group [16.7％ (5/30)] was significantly lower than that in control group [40.0％(12/30)] (P ＜0.05).Conclusions Compared with traditional unilateral craniotomy,bilateral decompressive craniotomy can reduce the incidence of acute brain swelling and incisional hernia of DHSCBI patients,and have better prognosis.It is worthy of clinical application.
