重型颅脑损伤患者改良大骨瓣减压术中渐进减压与常规减压对比观察

发布时间：2018-02-12 15:53

本文关键词： 重型颅脑损伤颅内压改良大骨瓣减压术格拉斯哥昏迷评分格拉斯哥预后评分　出处：《山东医药》2017年27期 　论文类型：期刊论文

【摘要】：目的对比观察重型颅脑损伤患者改良大骨瓣减压术中渐进减压与常规减压的应用效果。方法重型颅脑损伤患者80例,以随机数字表法分为对照组和观察组各40例。两组均行改良大骨瓣减压术,对照组患者采用常规减压手术方案;观察组采用渐进减压手术方案,即在硬膜下血肿大部分排出后,作颞部近骨窗处切口,行硬膜外引流。分别于术前及术后1、3、5 d采用格拉斯哥昏迷评分(GCS)评价神经功能损伤程度,采用BJM428型颅内压监护仪检测颅内压。记录术后并发症发生情况,包括术后切口疝及脑脊液漏、颅内感染、外伤性癫痫及脑积水。术后3个月采用格拉斯哥预后评分(GOS)分级评价远期预后。结果两组术后3、5 d GCS均高于术前,且观察组术后3、5 d GCS高于对照组(P均0.05)。两组术后1、3、5 d颅内压均低于术前,且观察组术后1、3、5 d颅内压低于对照组(P均0.05)。观察组术后切口疝及脑脊液漏、颅内感染发生率均低于对照组(P均0.05)。观察组良好、中度残疾、植物生存及死亡分级均显著优于对照组(P均0.05)。结论重型颅脑损伤改良大骨瓣减压术中采用渐进减压可有效促进患者受损神经功能恢复,控制颅内压,降低手术并发症发生率,改善患者预后,效果优于常规减压。
[Abstract]:The application effect of progressive decompression and decompression routine observation of patients with severe craniocerebral injury modified decompressive craniectomy. Methods 80 cases of patients with severe craniocerebral injury were randomly divided into control group and observation group with 40 cases in each group. The two groups were treated with modified decompressive craniectomy, the control group was treated with conventional decompression scheme the observation group with progressive decompression surgery; subdural hematoma in solution, i.e. most after discharge, as the temporal bone window near the incision of epidural drainage. Before and after surgery to 1,3,5 d by Glasgow Coma Scale (GCS) assessment of nerve function damage degree, the BJM428 type of intracranial pressure monitor intracranial pressure measurement. The incidence of complications were recorded, including intracranial infection and cerebrospinal fluid leakage of incision hernia, postoperative epilepsy, traumatic brain injury and water. After 3 months using the Glasgow Outcome Scale (GOS) assessment long-term prognosis. Results The two group after 3,5 D GCS were higher than before, and the observation group after 3,5 D GCS was higher than the control group (P < 0.05). Two groups of postoperative 1,3,5 D intracranial pressure were lower than those before operation, and the patients in the observation group 1,3,5 D intracranial pressure lower than that of the control group (P 0.05) hernia and cerebrospinal fluid. Incision leakage after operation in the observation group, the incidence of intracranial infection were lower than the control group (P < 0.05). The observation group is good, moderate disability, plant life and death classification were significantly better than the control group (P < 0.05). Conclusion the modified large trauma craniotomy of severe head injury in the patients with progressive decompression can effectively promote the injured nerve functional recovery, control of intracranial pressure, reduce the incidence of complications, improve the prognosis of the patients. The effect is better than that of conventional decompression.

【作者单位】：保定市第一中心医院总院;鸡西鸡矿医院有限公司职业病防治院;吉林大学药学院;
【分类号】：R651.15

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