中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2015年
5期
390-394
,共5页
王伟%龙连圣%赵耀东%辛志成%李夏良%蒋超超%苏强%吴钟华%章元
王偉%龍連聖%趙耀東%辛誌成%李夏良%蔣超超%囌彊%吳鐘華%章元
왕위%룡련골%조요동%신지성%리하량%장초초%소강%오종화%장원
颅脑损伤%硬膜%减压术,外科
顱腦損傷%硬膜%減壓術,外科
로뇌손상%경막%감압술,외과
Craniocerebral trauma%Dura mater%Decompression,surgical
目的 探讨采用人工硬膜减张缝合关闭硬脑膜对去骨瓣减压颅脑创伤患者的脑保护作用. 方法 回顾性分析因颅脑创伤单侧标准外伤大骨瓣减压后行人工硬膜关闭硬脑膜(研究组52例)和未行硬脑膜关闭(对照组46例)患者的临床资料,比较两组术后CT影像、ICU住院天数、伤后12个月的格拉斯哥预后评分(GOS)、癫痫发生率、肢体瘫痪、巴塞尔指数(BI)、简易精神状态检查(M MSE)等参数. 结果 两组术后病程中CT影像减压窗区脑膨出后脑梗死发生率分别为4％(2/52)和22％ (10/46) (P ＜0.05).研究组恢复良好率、重残率分别为33％(17/52)、10％ (5/52),对照组分别为15％(7/46)、26％ (12/46) (P ＜0.05).研究组病死率及生存患者癫痫发生率分别为19％(10/52)、19％(8/42),对照组分别为22％ (10/46)、19％ (7/36)(P ＞0.05).研究组生存患者ICU住院天数、肌力Ⅲ级以下的肢体瘫痪发生率、BI、MMSE分别为(8.7±4.3)d、10％(4/42)、(73.9±18.9)分、(23.5±7.0)分,对照组分别为(12.2-7.2)d、31％(11/36)、(51.6±21.8)分、(19.2±6.9)分(P＜0.05). 结论 采用人工硬膜减张缝合关闭硬脑膜能改善颅脑创伤后去骨瓣减压患者的日常活动能力及认知功能,有重要的脑保护作用.
目的 探討採用人工硬膜減張縫閤關閉硬腦膜對去骨瓣減壓顱腦創傷患者的腦保護作用. 方法 迴顧性分析因顱腦創傷單側標準外傷大骨瓣減壓後行人工硬膜關閉硬腦膜(研究組52例)和未行硬腦膜關閉(對照組46例)患者的臨床資料,比較兩組術後CT影像、ICU住院天數、傷後12箇月的格拉斯哥預後評分(GOS)、癲癇髮生率、肢體癱瘓、巴塞爾指數(BI)、簡易精神狀態檢查(M MSE)等參數. 結果 兩組術後病程中CT影像減壓窗區腦膨齣後腦梗死髮生率分彆為4％(2/52)和22％ (10/46) (P ＜0.05).研究組恢複良好率、重殘率分彆為33％(17/52)、10％ (5/52),對照組分彆為15％(7/46)、26％ (12/46) (P ＜0.05).研究組病死率及生存患者癲癇髮生率分彆為19％(10/52)、19％(8/42),對照組分彆為22％ (10/46)、19％ (7/36)(P ＞0.05).研究組生存患者ICU住院天數、肌力Ⅲ級以下的肢體癱瘓髮生率、BI、MMSE分彆為(8.7±4.3)d、10％(4/42)、(73.9±18.9)分、(23.5±7.0)分,對照組分彆為(12.2-7.2)d、31％(11/36)、(51.6±21.8)分、(19.2±6.9)分(P＜0.05). 結論 採用人工硬膜減張縫閤關閉硬腦膜能改善顱腦創傷後去骨瓣減壓患者的日常活動能力及認知功能,有重要的腦保護作用.
목적 탐토채용인공경막감장봉합관폐경뇌막대거골판감압로뇌창상환자적뇌보호작용. 방법 회고성분석인로뇌창상단측표준외상대골판감압후행인공경막관폐경뇌막(연구조52례)화미행경뇌막관폐(대조조46례)환자적림상자료,비교량조술후CT영상、ICU주원천수、상후12개월적격랍사가예후평분(GOS)、전간발생솔、지체탄탄、파새이지수(BI)、간역정신상태검사(M MSE)등삼수. 결과 량조술후병정중CT영상감압창구뇌팽출후뇌경사발생솔분별위4％(2/52)화22％ (10/46) (P ＜0.05).연구조회복량호솔、중잔솔분별위33％(17/52)、10％ (5/52),대조조분별위15％(7/46)、26％ (12/46) (P ＜0.05).연구조병사솔급생존환자전간발생솔분별위19％(10/52)、19％(8/42),대조조분별위22％ (10/46)、19％ (7/36)(P ＞0.05).연구조생존환자ICU주원천수、기력Ⅲ급이하적지체탄탄발생솔、BI、MMSE분별위(8.7±4.3)d、10％(4/42)、(73.9±18.9)분、(23.5±7.0)분,대조조분별위(12.2-7.2)d、31％(11/36)、(51.6±21.8)분、(19.2±6.9)분(P＜0.05). 결론 채용인공경막감장봉합관폐경뇌막능개선로뇌창상후거골판감압환자적일상활동능력급인지공능,유중요적뇌보호작용.
Objective To investigate the brain protection of tension suture of dura-mater with artificial dura after decompressive craniectomy in craniocerebral trauma.Methods The study retrospectively analyzed craniocerebral trauma patients managed with standard decompressive craniectomy in the presence (study group,n =52) or absence of dura mater close (control group,n =46).Clinical data,such as postoperative CT images,days of stay in ICU,Glasgow Outcome Scale (GOS) 12 months after injury,morbidity of epilepsy,acroparalysis,Barthel index (BI) and mini-mental status examination (MMSE) were analyzed and compared between the two groups.Results Occurrence rates of combined encephalocele and cerebral infarction around skull windows according to post-operative CT scan were 4％ (2/52) in study group and 22％ (10/46) in control group (P ＜0.05).Ratios for good-recovery (GOS =5) and severe disability (GOS =3) were respectively 33％ (17/52) and 10％ (5/52) in study group,and they were 15％ (7/46) and 26％ (12/46) in control group (P ＜0.05).For study and control groups mortality [19％ (10/52) vs 22％ (10/46)] and epilepsy ratio among the survivors [19％ (8/42) vs 19％ (7/36)] were comparable (P ＞ 0.05),but days of stay in ICU [(8.7 ± 4.3) d vs (12.2 ±7.2) d],acroparalysis (myodynamia ＜ grade Ⅲ) [10％ (4/42) vs 31％ (11/36)],BI [(73.9±18.9) vs (51.6±21.8)] and MMSE [(23.5 ±7.0) vs (19.2 ±6.9)] were significantly different (P ＜ 0.05).Conclusion To close the dura-mater by tension-reduced suture with artificial dura suggests a good protective effect on brain function,for it improves the daily activity capabilities and cognitive function in craniocerebral trauma patients treated with decompressive craniectomy.
