双额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀的临床研究(1)
[摘要]目的 探究雙额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀的临床效果。方法 选取我院2014年12月～2015年12月收治的60例脑外伤后难治性弥漫性脑肿胀患者作为研究对象，采用随机分方法将患者随机分配为对照组、观察组，每组30例。对照组采用常规降颅压和脱水治疗后效果不明显，采取苯巴比妥法等措施进一步降低颅内压。观察组在对照组治疗基础上实施双额大骨瓣减压术进行治疗。从患者入院后到手术治疗前记录、观察两组患者颅内压变化情况；手术治疗后两组患者每月进行格拉斯哥预后评分(GOS)并记录相应并发症的发生情况，连续观察6个月。结果 两组患者入院时的颅内压水平差异无统计学意义(P>0.05)，观察组患者颅内压水平治疗后较入院前明显降低，且治疗后，观察组颅内压明显低于对照组(P<0.05)。观察组总有效率(93.33 %)明显高于对照组(73.33 %)(P<0.05)。结论 双额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀具有显著效果，能明显降低患者颅内压，提高临床有效率，值得临床推广应用。
[关键词]双额大骨瓣减压术；脑外伤；难治性弥漫性脑肿胀
[中图分类号] R651.1+5 [文献标识码] A [文章编号] 1674-4721(2016)11(a)-0037-03
Clinical study of double frontal and large bone flap decompression treating refractory diffuse brain swelling after brain injury
PENG Mu-jian SHEN Jian-zhong ZHOU Liang
Department of Neurosurgery，Affiliated Hospital of Jinggangshan University in Jiangxi Province，Ji′an 343000，China
[Abstract]Objective To explore the clinical effect of double frontal and large bone flap decompression treating refractory diffuse brain swelling after brain injury.Methods 60 cases with refractory diffuse brain swelling after brain injury treated by our hospital from December 2014 to December 2015 were selected as the study subject.60 patients were randomly allocated to control group and observation group according to the random allocation method and there were 30 patients in each group.In control group， conventional reduction of intracranial pressure and dehydration was given but the curative effect was not obvious，Phenobarbital method and other measurses to further reduce the intracranial pressure.Observation group was treated by double frontal and large bone flap decompression on the basis of the treatment of control group.The change of intracranial pressure of patients in two groups was recorded and observed from the patients admitted to the hospital to before operation.Glasgow outcome scale (GOS) score was conducted per month and incidence of corresponding complication was recorded of patients in two groups after operation.Patients were observed for 6 consecutive months.Results There was no significant difference of the level of intracranial pressure between two groups on admission (P>0.05).The level of intracranial pressure of patients in observation group after treatment was significantly reduced compared with before admission，and intracranial pressure in observation group after treatment was significantly than that of control group (P<0.05).The total effective rate of observation group (93.33%) was significantly higher than that of control group (73.33%) (P<0.05).Conclusion Double frontal and large bone flap decompression treating refractory diffuse brain swelling after brain injury has a significant effect，and it can significantly reduce the intracranial pressure of patients，improve clinical efficiency.It is worthy of clinical application. (彭慕建 沈建忠 周亮)
[关键词]双额大骨瓣减压术；脑外伤；难治性弥漫性脑肿胀
[中图分类号] R651.1+5 [文献标识码] A [文章编号] 1674-4721(2016)11(a)-0037-03
Clinical study of double frontal and large bone flap decompression treating refractory diffuse brain swelling after brain injury
PENG Mu-jian SHEN Jian-zhong ZHOU Liang
Department of Neurosurgery，Affiliated Hospital of Jinggangshan University in Jiangxi Province，Ji′an 343000，China
[Abstract]Objective To explore the clinical effect of double frontal and large bone flap decompression treating refractory diffuse brain swelling after brain injury.Methods 60 cases with refractory diffuse brain swelling after brain injury treated by our hospital from December 2014 to December 2015 were selected as the study subject.60 patients were randomly allocated to control group and observation group according to the random allocation method and there were 30 patients in each group.In control group， conventional reduction of intracranial pressure and dehydration was given but the curative effect was not obvious，Phenobarbital method and other measurses to further reduce the intracranial pressure.Observation group was treated by double frontal and large bone flap decompression on the basis of the treatment of control group.The change of intracranial pressure of patients in two groups was recorded and observed from the patients admitted to the hospital to before operation.Glasgow outcome scale (GOS) score was conducted per month and incidence of corresponding complication was recorded of patients in two groups after operation.Patients were observed for 6 consecutive months.Results There was no significant difference of the level of intracranial pressure between two groups on admission (P>0.05).The level of intracranial pressure of patients in observation group after treatment was significantly reduced compared with before admission，and intracranial pressure in observation group after treatment was significantly than that of control group (P<0.05).The total effective rate of observation group (93.33%) was significantly higher than that of control group (73.33%) (P<0.05).Conclusion Double frontal and large bone flap decompression treating refractory diffuse brain swelling after brain injury has a significant effect，and it can significantly reduce the intracranial pressure of patients，improve clinical efficiency.It is worthy of clinical application. (彭慕建 沈建忠 周亮)