CAJ | 학술논문

目的探讨双额叶脑挫裂伤的治疗策略及进展恶化的相关危险因素.方法回顾性分析2011年12月至2014年12月收治61例双侧额叶脑挫裂伤患者临床资料.所有患者入院后行脑室型颅内压探头植入术,术后持续监测颅内压及引流脑脊液,当病情出现进展恶化时即开颅手术治疗.结果病情未恶化、保守治疗38例(62％);病情恶化并行手术治疗23例(38％),两组之间预后比较差异无统计学意义(P＞0.05).额角间夹角＞ 120°、额叶挫裂伤散在、额叶血肿(水肿)超过双侧蝶骨嵴连线是导致恶化发生的独立危险因素(P＜0.05).结论颅内压监测是治疗双额叶脑挫伤的基础,通过脑脊液引流等治疗措施严格控制颅内压在20 mmHg以下,是保守治疗成功的关键.额角间夹角＞ 120°可以作为一个量化的开颅手术指征,同时额叶挫裂伤散在、额叶血肿(水肿)超过双侧蝶骨嵴连线也可作为开颅手术的参考指标.
목적 탐토쌍액협뇌좌렬상적치료책략급진전악화적상관위험인소.방법 회고성분석2011년12월지2014년12월수치61례쌍측액협뇌좌렬상환자림상자료.소유환자입원후행뇌실형로내압탐두식입술,술후지속감측로내압급인류뇌척액,당병정출현진전악화시즉개로수술치료.결과 병정미악화、보수치료38례(62％);병정악화병행수술치료23례(38％),량조지간예후비교차이무통계학의의(P＞0.05).액각간협각＞ 120°、액협좌렬상산재、액협혈종(수종)초과쌍측접골척련선시도치악화발생적독립위험인소(P＜0.05).결론 로내압감측시치료쌍액협뇌좌상적기출,통과뇌척액인류등치료조시엄격공제로내압재20 mmHg이하,시보수치료성공적관건.액각간협각＞ 120°가이작위일개양화적개로수술지정,동시액협좌렬상산재、액협혈종(수종)초과쌍측접골척련선야가작위개로수술적삼고지표.
Objective To investigate the treatment strategies of bifrontal contusions and the related risk factors for progress deterioration.Methods The clinical data of 61 patients with bifrontal contusions treated from December 2011 to December 2014 were analyzed retrospectively.All patients performed the probe implantion of intraventricular intracranial pressure after admission.Postoperative intracranial pressure and drainage of cerebrospinal fluid were monitored continuously.When the disease progressed and deteriorated,the craniotomy was performed immediately.Results The conditions of 38 patients (62％) were not worsening and were treated conservatively;those of 23 patients (38％) were worsening and were treated surgically.There was significant difference in the prognoses between the two groups (P ＞ 0.05).The angle between the frontal horns ＞ 120°,scattered frontal contusion,frontal hematoma (edema) over bilateral sphenoid ridge line were the independent risk factors for leading to the occurrence of deterioration (P ＜ 0.05).Conclusions Intracranial pressure monitoring is the basis for the treatment of bifrontal contusions.Strictly controlling the intracranial pressure under the 20 mm Hg by using cerebrospinal fluid drainage and other therapeutic measures is the key to the success of conservative treatment.The angle between the frontal horns ＞ 120° can be used as a quantitative indication of craniotomy,at the same time,scattered frontal contusion,frontal hematoma (edema) over bilateral sphenoid ridge line can also be used as the reference indices of craniotomy.