标准大骨瓣减压术治疗重型创伤性脑损伤临床观察(1)
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[摘要] 目的 探讨标准大骨瓣减压术治疗重型创伤性脑损伤的临床疗效。 方法 126例重型创伤性脑损伤患者按照入院顺序分为两组，其中76例接受标准大骨瓣减压术(标准大骨瓣组)，50例接受常规骨瓣减压术(常规骨瓣组)；术后连续7 d观察两组患者的颅内压，术后6个月进行GOS评分。 结果 标准大骨瓣组患者术后第1、2、7天颅内压明显低于常规骨瓣组患者，二者比较差异有统计学意义(P < 0.05)；标准大骨瓣组患者GOS评分优良(良好+中残)率为71.1%，显著高于常规骨瓣组的48.0%，二者比较差异有统计学意义(P < 0.05)。 结论 采用标准大骨瓣减压术可有效降低重型创伤性脑损伤患者的颅高压、病死率和致残率，提高治疗效果。
[关键词] 重型创伤性脑损伤；大骨瓣；常规骨瓣
[中图分类号] R651 [文献标识码] A [文章编号] 1673-7210(2012)02(a)-0032-02
Clinical observation of standard decompression with large craniectomy for severe traumatic brain injury
NIE Youming
Department of Neurosurgery, the Fourth People's Hospital of Yongzhou City，Hu′nan Province, Yongzhou 415006, China
[Abstract] Objective To explore clinical curative effect of standard decompression with large craniectomy for severe traumatic brain injury. Methods 126 patients of severe traumatic brain injury were divided into two groups according to the hospital order, 76 patients accepted standard decompression with large craniectomy, 50 patients accepted routine craniectomy. For 7 days after surgery, the intracranial pressure and after 6 months the GOS scores were detected. Results The intracranial pressure of the postoperative 1, 2 and 7 days of standard decompression with large craniectomy group was significantly lower than the routine craniectomy group (P < 0.05). The excellent rate (good and residual) for GOS score of large craniectomy group (71.1%) was significantly higher than routine craniectomy group (48.0%) (P < 0.05). Conclusion The standard decompression with large craniectomy can reduce the intracranial pressure of severe traumatic brain injury, and reduce mortality and morbidity of severe brain injury.
[Key words] Severe traumatic brain injury; Large craniectomy; Routine craniectomy
重型创伤性脑损伤(severe traumatic brain injury，sTBI)病死率和伤残率均很高，预后差[1]。大多数sTBI患者病情较为危重，治疗颇为困难，因此快速准确地诊断和手术治疗是救治成功的关键。sTBI重要病理改变是恶性颅内压升高，常规去骨瓣减压效果往往不佳。标准脑外伤去大骨瓣减压术是近年来国内外普遍采用的治疗sTBI的一种安全、有效的手术方式[2]。我院在2001年5月~2011年5月之间共收治1 125例颅脑损伤患者，其中sTBI患者为206例。上述sTBI患者中接受手术治疗为126例，其中76例接受了标准大骨瓣减压术，50例实施常规骨瓣减压术。现将上述病例回顾分析并报道如下：
1 资料与方法
1.1 一般资料
根据上述诊断标准，选取我院2001年5月～2011年5月接受手术治疗的126例sTBI患者 ......
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