CAJ | 학술논문

目的：对颅脑外伤去大骨瓣减压术后并发脑膨出、颅内血肿及脑梗死的情况进行临床分析。方法选取2012~2013年接受诊治的56例颅脑外伤并行大骨瓣减压术的患者作为研究对象。于术后8周后对所有患者进行格拉斯哥预后评分，统计分析各级患者并发脑膨出、颅内血肿及脑梗死的情况。结果颅脑外伤经去大骨瓣减压术后并发脑膨出患者43例（76.8％），并发颅内血肿患者32例（57.1％），并发脑梗死患者7例（12.5％）。并发脑膨出患者在术后1周至2周期间脑膨出情况明显加重，且差异具有统计学意义（ t =17.4772，P =0.0001）。56例患者有32例并发脑内血肿或（和）脑挫裂伤扩大的情况，其中96.9％的患者于术后3 d 内即出现病灶。术后共有12例（21.4％）患者并发脑梗死，预后不良组与预后良好组脑梗死发生率差异具有统计学意义（χ2=4.384，P =0.043）。结论颅脑外伤去大骨瓣减压术后易并发脑膨出、颅内血肿及脑梗死，是临床致死、致残的主要因素之一，其中以脑梗死对患者预后不良影响最为明显。临床上对颅脑外伤患者手术应严格掌握手术适应证，尽可能减少术后并发症。
목적：대로뇌외상거대골판감압술후병발뇌팽출、로내혈종급뇌경사적정황진행림상분석。방법선취2012~2013년접수진치적56례로뇌외상병행대골판감압술적환자작위연구대상。우술후8주후대소유환자진행격랍사가예후평분，통계분석각급환자병발뇌팽출、로내혈종급뇌경사적정황。결과로뇌외상경거대골판감압술후병발뇌팽출환자43례（76.8％），병발로내혈종환자32례（57.1％），병발뇌경사환자7례（12.5％）。병발뇌팽출환자재술후1주지2주기간뇌팽출정황명현가중，차차이구유통계학의의（ t =17.4772，P =0.0001）。56례환자유32례병발뇌내혈종혹（화）뇌좌렬상확대적정황，기중96.9％적환자우술후3 d 내즉출현병조。술후공유12례（21.4％）환자병발뇌경사，예후불량조여예후량호조뇌경사발생솔차이구유통계학의의（χ2=4.384，P =0.043）。결론로뇌외상거대골판감압술후역병발뇌팽출、로내혈종급뇌경사，시림상치사、치잔적주요인소지일，기중이뇌경사대환자예후불량영향최위명현。림상상대로뇌외상환자수술응엄격장악수술괄응증，진가능감소술후병발증。
Objective To analyze the clinical expression of craniocerebral trauma patient complicated with encephalocele,intracranial he-matoma and cerebral infarction after decompressive craniectomy. Methods 56 patients of craniocerebral trauma were included into this study. All patients were diagnosed and treated with decompressive craniectomy in our hospital between 2012 ~ 2013,as the research object. All patients were taken GOS grade at postoperative 8 weeks,statistical analysis at all levels of patients with concurrent encephalocele,intracranial hematoma and cerebral infarction. Results After decompressive craniectomy,craniocerebral trauma with concurrent encephalocele were 43 cases(76. 8% ),32 cases(57. 1% )with intracranial hematoma patients,and 7 cases(12. 5% )with cerebral infarction patients. Comparing patients with postopera-tive 1 week and 2 weeks after contrast encephalocele,patients in the postoperative period 1 to 2 week bulging diencephalon is significantly in-creased. The difference is statistically significant( t = 17. 4772,P = 0. 0001). 32 in 56 cases complicated with brain hematoma or(and)cere-bral contusion of expanding. 96. 9% of the patients was postoperative 3 d within the lesion. After a total of 12 cases(21. 4% )patients complicat-ed with cerebral infarction,the difference is statistically significant between GOS Ⅰ - Ⅲ and GOS Ⅳ - Ⅴ two groups(χ2 = 4. 384,P = 0. 043). Conclusion Craniocerebral trauma to the big bone flap decompression with can complicate concurrent encephalocele,intracranial hematoma and cerebral infarction. In all these complications,cerebral infarction is one of the main factors of clinical death and disability,of which the most influ-ence on prognosis in patients was cerebral infarction,Therefore,the clinical surgery in patients with craniocerebral trauma should master the opera-tion indications strictly,as far as possible to reduce the postoperative complications.