CAJ | 학술논문

目的：探讨标准大骨瓣减压术治疗重型颅脑损伤患者的临床疗效。方法选择重型颅脑损伤患者58例，按照手术方法不同，将其分为对照组和研究组，每组各29例，对照组采用常规的骨瓣开颅手术，研究组采用去大骨瓣减压手术。术后比较两组临床效果及并发症发生情况。结果术后随访5个月，研究组死亡率（10．34％）明显低于对照组（27．59％），且差异有统计学意义（χ2＝3．98，P ＜0．05）；研究组良好率（55.17％）明显高于对照组（27．59％），且差异有统计学意义（χ2＝4．55，P ＜0．05）。两组术前颅内压差异无统计学意义（P ＞0．05）；而术后1 d、3 d 及5 d 研究组颅内压明显低于对照组，且差异有统计学意义（t ＝3．55、4．02、6．12，均 P ＜0．05）。研究组 GOS 和 BAI 评分均较对照组明显升高，且差异有统计学意义（t ＝5．02、4.21，P ＜0．05）。研究组脑脊液漏、外伤性脑梗死、外伤性癫痫、脑积水、伤口感染等并发症发生率均明显低于对照组，且差异有统计学意义（χ2＝4．00、5．02、4．56、4．22、3．99，均 P ＜0．05）。结论标准大骨瓣减压术较常规骨瓣开颅术视野开阔，大大降低了病死率，降颅压更显著，改善和提高了患者的生存质量，对重型颅脑损伤的疗效及预后更优，值得临床应用。
목적：탐토표준대골판감압술치료중형로뇌손상환자적림상료효。방법선택중형로뇌손상환자58례，안조수술방법불동，장기분위대조조화연구조，매조각29례，대조조채용상규적골판개로수술，연구조채용거대골판감압수술。술후비교량조림상효과급병발증발생정황。결과술후수방5개월，연구조사망솔（10．34％）명현저우대조조（27．59％），차차이유통계학의의（χ2＝3．98，P ＜0．05）；연구조량호솔（55.17％）명현고우대조조（27．59％），차차이유통계학의의（χ2＝4．55，P ＜0．05）。량조술전로내압차이무통계학의의（P ＞0．05）；이술후1 d、3 d 급5 d 연구조로내압명현저우대조조，차차이유통계학의의（t ＝3．55、4．02、6．12，균 P ＜0．05）。연구조 GOS 화 BAI 평분균교대조조명현승고，차차이유통계학의의（t ＝5．02、4.21，P ＜0．05）。연구조뇌척액루、외상성뇌경사、외상성전간、뇌적수、상구감염등병발증발생솔균명현저우대조조，차차이유통계학의의（χ2＝4．00、5．02、4．56、4．22、3．99，균 P ＜0．05）。결론표준대골판감압술교상규골판개로술시야개활，대대강저료병사솔，강로압경현저，개선화제고료환자적생존질량，대중형로뇌손상적료효급예후경우，치득림상응용。
Objective To investigate the clinical effect of standard large bone flap decompression for severe craniocerebral injury.Methods This study was performed in 58 patients with severe traumatic brain injury,according to different surgical methods,the patients were divided into control group and study group,29 cases in each group.The control group was treated with conventional bone flap craniotomy,and the study group was treated with large bone flap decompression surgery.The clinical effect and complications were compared between the two groups.Results After operation,the patients were followed up for 5 months.The mortality of the study group (10.34%)was significantly lower than that of the control group (27.59%),and the difference was statistically significant (χ2 =3.98,P <0.05).In addition,the good rate of the study group (55.17%)was significantly higher than that of the control group (27.59%),and the difference was significant (χ2 =4.55,P <0.05).The preoperative intracranial pressure had no significant difference between the two groups.While at postoperative 1d,3d and 5d,the intracranial pressure of the study group was significantly lower than that of the control group,and the difference was statistically significant (t =3.55,4.02,6.12,all P <0.05).The scores of GOS and BAI in the study group were significantly higher than those in the control group (t =5.02,4.21,P <0.05 ).The incidence rates of complications such as cerebrospinal fluid leakage,trauma of cerebral infarction,trauma of epilepsy,hydrocephalus,wound infection of the study group were sig-nificantly lower than those of the control group,and the differences were statistically significant (χ2 =4.00,5.02, 456,4.22,3.99,all P <0.05).Conclusion Compared with conventional craniotomy,open standard big bone flap decompression can significantly reduce the mortality rate,decrease intracranial pressure,and improve the quality of life of patients,it has better curative effect and prognosis for patients with severe craniocerebral injury,and is worthy of clinical application.