CAJ | 학술논문

目的探讨无中线移位的重型颅脑外伤致急性弥漫性脑肿胀(PADBS)的临床治疗方法及疗效.方法对60例PADBS患者通过数字表法随机分为保守治疗组(n=30)和手术组(n=30),分别给予保守治疗和颅内压监护探头置人及行去骨瓣减压手术治疗,观察两组术后恢复情况.结果手术组在治疗7d和15 d后,GCS评分分别为(11.21±2.24)分、(12.88 ±2.31)分,明显高于保守治疗组的(7.47±1.51)分、(8.19±1.28)分(t=2.215、2.321,均P＜0.05);术后随访显示,根据GOS评分,手术组治疗效果在术后恢复良好者(63.3％)明显高于保守治疗组(26.7％),在术后昏迷(6.7％)和死亡(10.0％)患者明显低于保守治疗组(x2=15.721、4.172、3.84,均P＜0.05).结论在保守治疗基础上的颅内压监护探头置入及行去骨瓣减压治疗PADBS有助于客观评价创伤,及早发现病情变化,降低病死率.
목적 탐토무중선이위적중형로뇌외상치급성미만성뇌종창(PADBS)적림상치료방법급료효.방법 대60례PADBS환자통과수자표법수궤분위보수치료조(n=30)화수술조(n=30),분별급여보수치료화로내압감호탐두치인급행거골판감압수술치료,관찰량조술후회복정황.결과 수술조재치료7d화15 d후,GCS평분분별위(11.21±2.24)분、(12.88 ±2.31)분,명현고우보수치료조적(7.47±1.51)분、(8.19±1.28)분(t=2.215、2.321,균P＜0.05);술후수방현시,근거GOS평분,수술조치료효과재술후회복량호자(63.3％)명현고우보수치료조(26.7％),재술후혼미(6.7％)화사망(10.0％)환자명현저우보수치료조(x2=15.721、4.172、3.84,균P＜0.05).결론 재보수치료기출상적로내압감호탐두치입급행거골판감압치료PADBS유조우객관평개창상,급조발현병정변화,강저병사솔.
Objective To investigate the clinical efficacy and treatment method for no midline shift-severe craniocerebral trauma accompanied with post-traumatic acute diffuse brain swelling (PADBS).Methods 60 PADBS patients were randomly divided into conservative treatment group and operation group,30 patients in each group.The operation group was treated with intracranial pressure monitoring by implantation of the probe and decompressive craniectomy,while the conservative treatment group received conservative treatment.The postoperative recovery was observed.Results The GCS scores of operation group postoperative 7d and 15d were (11.21 ± 2.24) and (12.88 ±2.31),which were obviously higher than (7.47 ± 1.51) and (8.19 ± 1.28) of the conservative treatment group (t =2.215,2.321,all P ＜ 0.05).Postoperative long-term follow-up results indicated that,according to GOS score,63.3％ patients in the operation group recovered well,which was significantly higher than 26.7％ in the conservative treatment group.While the percent of patients with coma or dead was 6.7％ and 10.0％ in the operation group,which were significantly lower than the conservative treatment group (x2 =15.721,4.172,3.84,all P ＜ 0.05).Conclusion In general,PADBS could not be cured easliy,the operation methods of using intracranial pressure monitoring and decompressive craniectomy based on conservative treatment could help to evaluate the trauma objectivly,detect the changes of disease earlier,treat in time and assess the prognosis accurately,all which would reduce the mortality.