CAJ | 학술논문

目的：探讨分析预见性双侧去骨瓣减压术（ BDC）与相继性双侧去骨瓣减压术治疗重型颅脑损伤的临床疗效差异，为临床优化治疗方案提供参考。方法将122例的重型颅脑损伤患者随机分为观察组和对照组。术后治疗方案基本相同，治疗3个月后患者均行格拉斯哥预后评分（ GOS），比较两组患者术中急性脑组织膨出及术后切口疝发生率、GOS评分及并发症情况。结果术后观察组术中急性脑组织膨出、术后切口疝发生率均明显低于对照组（P＜0．05）。观察组GOS评分良好率明显高于对照组（P＜0．05），观察组病死率明显低于对照组（P＜0．05）。观察组中残率、重残率、植物化生存率与对照组比较，差异均无统计学意义（均P＞0．05）。观察组术后并发症发生率明显低于对照组（P＜0．05）。结论预见性双侧去骨瓣减压术用于治疗重型颅脑损伤近期临床疗效优于相继性双侧去骨瓣减压术，可显著改善预后及降低并发症，值得在临床推广应用。
목적：탐토분석예견성쌍측거골판감압술（ BDC）여상계성쌍측거골판감압술치료중형로뇌손상적림상료효차이，위림상우화치료방안제공삼고。방법장122례적중형로뇌손상환자수궤분위관찰조화대조조。술후치료방안기본상동，치료3개월후환자균행격랍사가예후평분（ GOS），비교량조환자술중급성뇌조직팽출급술후절구산발생솔、GOS평분급병발증정황。결과술후관찰조술중급성뇌조직팽출、술후절구산발생솔균명현저우대조조（P＜0．05）。관찰조GOS평분량호솔명현고우대조조（P＜0．05），관찰조병사솔명현저우대조조（P＜0．05）。관찰조중잔솔、중잔솔、식물화생존솔여대조조비교，차이균무통계학의의（균P＞0．05）。관찰조술후병발증발생솔명현저우대조조（P＜0．05）。결론예견성쌍측거골판감압술용우치료중형로뇌손상근기림상료효우우상계성쌍측거골판감압술，가현저개선예후급강저병발증，치득재림상추엄응용。
Objective To investigate the clinical efficacy between the active bilateral decompressive craniectomy and successively bilateral decompression craniectomy ( BDC ) in the treatment of severe craniocerebral injury, to provide reference for optimizing clinical therapeutic regimen.Methods 121 patients with severe craniocerebral injury were selected and randomly divided into the observation group and the control group, patients in observation group were treated with active BDC,and patients in control group were treated with successively BDC.All the patients got the almost same therapeutic methods after operations.The Glasgow outcome score( GOS) of all patients in both groups was evaluated 3 months after treatment, the occurrence rate of intraoperative acute brain tissue bulging and postoperative incision hernia between the two groups were compared.GOS scores and complication were observed. Results After treatment,incidence of acute intraoperative encephalocele and incidence of postoperative incisional hernia of observation group patients were significantly lower than those of control group, the differences were statistically significant(P<0.05).GOS good rate of observation group was significantly higher than that of control group,the death rate of observation group was significantly lower than that of control group, the differences were statistically significant(P <0.05).The differences of moderate disability rate,severe disability rate,vegetative survival rate of observation group and control group were not statistically significant(P >0.05).Complication occurrence rate of observation group was lower than that of control group, the differences were statistically significant(P<0.05).Conclusion The active bilateral decompressive craniectomy in the treatment of severe craniocerebral injurycan effectively improve the prognosis of patients, and reduce the incidence of postoperative complications.And it is worthy to recommand its clinical application.