腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者并发症和预后的影响

发布时间：2018-06-03 02:34

本文选题：重型颅脑损伤 + 骨瓣减压控制术　；参考：《国际神经病学神经外科学杂志》2017年04期

【摘要】：目的探讨腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者并发症和预后的影响,以期为优化该类患者外科治疗提供参考性依据。方法选取2013年2月~2016年4月我院收治的重型颅脑损伤患者184例,按数字随机表法分为试验组和对照组,各92例,对照组患者采取骨瓣减压控制术治疗,试验组患者则在对照组患者的基础上联合腰大池持续引流术治疗,分别于术后3d、5d、7d检测患者颅内压(ICP),于术后6个月时采格拉斯哥预后评分(GPS)评估两组患者预后情况,详细记录两组患者脑水肿、脑梗死等术后并发症发生情况,并进行组间比较。结果试验组患者术后3d、5d、7d ICP值均明显低于对照组患者,差异具有统计学意义(P0.05);术后3d、5d、7d时试验组患者GCS评分均明显高于对照组患者,差异均具有统计学意义(P0.05);与对照组患者比较,试验组患者术后脑水肿发生率明显降低,脑水肿程度也明显减轻,差异均具有统计学意义(P0.05);与对照组患者比较,试验组患者术后脑梗死发生率明显降低,且梗死体积也明显缩小,差异均具有统计学意义(P0.05);术后6个月时,试验组患者预后良好率、预后不良率和死亡率分别为59.78%(55/92)、33.70%(31/92)、6.52%(6/92),对照组患者分别为39.13%(36/92)、50.00%(46/92)、10.87%(10/92),两组患者术后预后情况差异具有统计学意义(P0.05)。结论腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者的疗效显著,可有效降低ICP,改善预后,降低术后并发症的发生,效果优于仅采用骨瓣减压控制术。
[Abstract]:Objective to investigate the effect of lumbar cistern continuous drainage combined with bone flap decompression and control on the complications and prognosis of patients with severe craniocerebral injury in order to provide reference for optimizing surgical treatment of patients with severe craniocerebral injury. Methods 184 patients with severe craniocerebral injury admitted in our hospital from February 2013 to April 2016 were randomly divided into two groups: experimental group (n = 92) and control group (n = 92). Patients in control group were treated with bone flap decompression and control. The patients in the trial group were treated with continuous lumbar cistern drainage on the basis of the control group. The intracranial pressure (ICP) was measured at 3 days, 5 days and 7 days after operation. Glasgow prognosis score (GPSs) was used to evaluate the prognosis of the two groups at 6 months after operation. The postoperative complications such as cerebral edema and cerebral infarction were recorded in detail and compared between the two groups. Results the value of ICP in the trial group was significantly lower than that in the control group on the 3rd and 5th day after operation, the difference was statistically significant (P 0.05), the GCS score of the trial group was significantly higher than that of the control group on the 3rd day after operation, the difference was statistically significant (P 0.05), and the difference was significant compared with the control group. The incidence rate of postoperative cerebral edema and the degree of cerebral edema were significantly reduced in the trial group, and the difference was statistically significant (P 0.05), compared with the patients in the control group, the incidence of postoperative cerebral infarction in the trial group was significantly lower than that in the control group. The infarct volume was also significantly reduced, and the difference was statistically significant (P 0.05), and at 6 months after operation, the patients in the trial group had a good prognosis. The rates of poor prognosis and mortality were 59.78% and 33.70%, respectively. There was a significant difference in postoperative prognosis between the two groups (P 0.05). The ratio of 36 / 92% in the control group was 39.13% / 92% in the control group, respectively, and the mortality rate was 59.78%. The difference of the postoperative prognosis between the two groups was statistically significant (P 0.05), and that in the control group was 39.13% / 92% or 50.005 / 10 / 92.The difference of postoperative prognosis between the two groups was statistically significant (P < 0.05). Conclusion Lumbar cistern continuous drainage combined with bone flap decompression and control has a significant effect on severe craniocerebral injury. It can effectively reduce ICP, improve prognosis and reduce postoperative complications. The effect is better than that of bone flap decompression and control only.
【作者单位】：延安大学咸阳医院神经外科;
【分类号】：R651.15

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