中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
5期
37-39
,共3页
岑明%陈伟峰%宋显兴%蒋福刚%冯子民
岑明%陳偉峰%宋顯興%蔣福剛%馮子民
잠명%진위봉%송현흥%장복강%풍자민
脑损伤%脑水肿%减压术,外科%预后
腦損傷%腦水腫%減壓術,外科%預後
뇌손상%뇌수종%감압술,외과%예후
Brain injuries%Brain edema%Decompression,sugical%Prognosis
目的 探讨双侧额大骨瓣减压术对重型颅脑外伤致难治性弥漫性脑肿胀的治疗效果及并发症的防治.方法 回顾性分析68例重型颅脑外伤致难治性弥漫性脑肿胀患者的临床资料,根据患者在治疗过程中是否接受双侧额大骨瓣减压术分为两组,观察组35例入院后在不同时间内接受双侧额大骨瓣减压术,术后继续颅内压监测;对照组33例采用保守治疗降低颅内压,持续性颅内压监测.出院后6个月应用格拉斯哥预后量表评定疗效并统计观察组并发症发生情况.结果 观察组入院时颅内压为(35.9±6.9) mmHg(1 mmHg =0.133 kPa),从入院到手术的时间为2～16(10.5±4.2)h,术后颅内压为(17.5±5.2) mmHg,与入院时比较差异有统计学意义(P＜0.05).对照组入院时颅内压为(34.2±8.6) mmHg,入院后10.5 h时为(32.0±4.8)mmHg,与入院时比较差异无统计学意义(P＞0.05),与观察组术后颅内压比较差异有统计学意义(P＜0.05).观察组术后发生硬脑膜下积液2例,脑积水1例.术后6个月观察组预后较好率为45.7％(16/35),而对照组为18.2％(6/33),两组比较差异有统计学意义(P＜0.05).结论 双侧额大骨瓣减压术对重型颅脑外伤致难治性弥漫性脑肿胀是一种快速有效降低颅内压的方法,可改善患者预后,手术时机是影响预后的关键.
目的 探討雙側額大骨瓣減壓術對重型顱腦外傷緻難治性瀰漫性腦腫脹的治療效果及併髮癥的防治.方法 迴顧性分析68例重型顱腦外傷緻難治性瀰漫性腦腫脹患者的臨床資料,根據患者在治療過程中是否接受雙側額大骨瓣減壓術分為兩組,觀察組35例入院後在不同時間內接受雙側額大骨瓣減壓術,術後繼續顱內壓鑑測;對照組33例採用保守治療降低顱內壓,持續性顱內壓鑑測.齣院後6箇月應用格拉斯哥預後量錶評定療效併統計觀察組併髮癥髮生情況.結果 觀察組入院時顱內壓為(35.9±6.9) mmHg(1 mmHg =0.133 kPa),從入院到手術的時間為2～16(10.5±4.2)h,術後顱內壓為(17.5±5.2) mmHg,與入院時比較差異有統計學意義(P＜0.05).對照組入院時顱內壓為(34.2±8.6) mmHg,入院後10.5 h時為(32.0±4.8)mmHg,與入院時比較差異無統計學意義(P＞0.05),與觀察組術後顱內壓比較差異有統計學意義(P＜0.05).觀察組術後髮生硬腦膜下積液2例,腦積水1例.術後6箇月觀察組預後較好率為45.7％(16/35),而對照組為18.2％(6/33),兩組比較差異有統計學意義(P＜0.05).結論 雙側額大骨瓣減壓術對重型顱腦外傷緻難治性瀰漫性腦腫脹是一種快速有效降低顱內壓的方法,可改善患者預後,手術時機是影響預後的關鍵.
목적 탐토쌍측액대골판감압술대중형로뇌외상치난치성미만성뇌종창적치료효과급병발증적방치.방법 회고성분석68례중형로뇌외상치난치성미만성뇌종창환자적림상자료,근거환자재치료과정중시부접수쌍측액대골판감압술분위량조,관찰조35례입원후재불동시간내접수쌍측액대골판감압술,술후계속로내압감측;대조조33례채용보수치료강저로내압,지속성로내압감측.출원후6개월응용격랍사가예후량표평정료효병통계관찰조병발증발생정황.결과 관찰조입원시로내압위(35.9±6.9) mmHg(1 mmHg =0.133 kPa),종입원도수술적시간위2～16(10.5±4.2)h,술후로내압위(17.5±5.2) mmHg,여입원시비교차이유통계학의의(P＜0.05).대조조입원시로내압위(34.2±8.6) mmHg,입원후10.5 h시위(32.0±4.8)mmHg,여입원시비교차이무통계학의의(P＞0.05),여관찰조술후로내압비교차이유통계학의의(P＜0.05).관찰조술후발생경뇌막하적액2례,뇌적수1례.술후6개월관찰조예후교호솔위45.7％(16/35),이대조조위18.2％(6/33),량조비교차이유통계학의의(P＜0.05).결론 쌍측액대골판감압술대중형로뇌외상치난치성미만성뇌종창시일충쾌속유효강저로내압적방법,가개선환자예후,수술시궤시영향예후적관건.
Objective To analyze the effect of bifrontal decompressive craniectomy on patients with refractory diffusing of brain swelling after severe traumatic brain injury.Methods The clinical data of 68 patients with refractory diffusing of brain swelling after severe traumatic brain injury were analyzed retrospectively.Thirty-five patients were performed with bifrontal decompressive craniectomy as observed group,continued intracranial pressure monitoring after surgery.Thirty-three patients were treated conservatively to reduce intracranial pressure as control group,continued intracranial pressure monitoring.The Glasgow outcome scale after discharge 6 months were assessed.The efficacy,the incidence of complications were observed in observed group.Results The admission intracranial pressure in observed group was significantly higher than that after surgery [(35.9 ±6.9) mmHg (1 mmHg =0.133 kPa) vs.(17.5 ±5.2) mmHg,P ＜0.05].The admission intracranial pressure in control group was (34.2 ± 8.6) mmHg,after admission 10.5 h was (32.0 ±4.8) mmHg (P ＜0.05),difference was no statistically significant (P＞ 0.05).The intracranial pressure after admission 10.5 h in control group was significantly higher than that in observed group after surgery (P ＜0.05).Two cases of subdural effusion,1 case of postoperative hydrocephalus in observed group.The better prognosis rate in observed group was significantly higher than that in control group [45.7％ (16/35) vs.18.2％ (6/33),P ＜ 0.05].Conclusions Bifrontal decompressive craniectomy is a suitable measure to decrease the intracranial pressure in the patients with refractory diffusing of brain swelling.If carried out early,it could provide better outcome for these patients.
