硬脑膜减张缝合在神经外科中的疗效观察

发布时间：2018-09-08 12:33

【摘要】：目的:通过分析神经外科各种常见病原因造成的颅内高压,开颅术中硬脑膜不能原位缝合所采取的硬脑膜减张缝合与非减张缝合的两种手术方式,评估两种手术方法的优缺点,为临床选择最佳的手术方式提供参考,进一步改善手术质量,提高患者的治疗效果。方法:采取回顾性分析,通过收集延安大学附属医院神经外科2009年07月-2014年01月期间进行的开颅去骨瓣减压手术的病例96例,将所选取的病例随机分为硬脑膜减张缝合组(实验组,n=46)与非减张组(对照组,n=50)。两组患者术后均采取适度的降颅压措施,同时给予营养神经、预防癫痫、肠外营养支持、维持机体电解质平衡、预防坠积性肺炎、防止应激性溃疡等对症治疗措施,复查头颅CT明确病情变化。收集两组患者的一般资料,术前GCS评分,手术时间及术中出血量,术后抗生素使用时间,脑脊液漏、感染、皮下积液、骨窗疝、癫痫等发生的情况,出院时应用Barthel日常生活活动能力量表评估日常生活活动能力。采用SPSS17.0软件对两组数据进行分析,找出差异以得到结论。结果:两组患者的手术时间和术中出血量相比较无明显统计学差异(P㧐0.05);与非减张组在术后癫痫、脑脊液漏、骨窗疝、皮下积液等并发症的发病率相比,硬脑膜减张缝合组明显优于前者(P0.05);日常生活质量评估(ADL):Barthel指数得分20分以上的患者硬脑膜减张缝合组明显优于非减张组(P㩳0.05),得分在20分以下的患者减张缝合组和非减张组无显著差异(P㧐0.05)。结论:硬脑膜减张缝合可以有效降低颅内高压,降低术后癫痫、脑脊液漏、感染、皮下积液、骨窗疝的发生率,并能有效提高患者的预后效果。
[Abstract]:Objective: to evaluate the advantages and disadvantages of the two operative methods of dural tension-reduction suture and non-tension-free suture by analyzing the intracranial hypertension caused by various common diseases in neurosurgery, and to evaluate the advantages and disadvantages of the two surgical methods, in which the dura mater can not be sutured in situ during craniotomy. To provide a reference for clinical selection of the best operation, further improve the quality of surgery, improve the treatment of patients. Methods: by retrospective analysis, 96 cases of craniotomy and decompression of craniotomy were collected from Neurosurgery Department, affiliated Hospital of Yan'an University, from July 2009 to January 2014. The selected cases were randomly divided into two groups: the dural hypotonic suture group (experimental group) and the control group (control group). The patients in both groups took appropriate measures of lowering intracranial pressure after operation, and were given nutritional nerve, prevention of epilepsy, parenteral nutrition support, maintenance of electrolyte balance, prevention of falling pneumonia, prevention of stress ulcer and other symptomatic treatment measures. The changes of the disease were confirmed by CT. The general data of the two groups were collected, including preoperative GCS score, operative time and intraoperative bleeding, postoperative antibiotic use time, cerebrospinal fluid leakage, infection, subcutaneous effusion, bone window hernia, epilepsy and so on. The activity of daily living (ADL) was evaluated with the Barthel activity of Daily living (ADL) scale when discharged from hospital. SPSS17.0 software is used to analyze the two groups of data and find out the difference. Results: there was no significant difference in operative time and intraoperative bleeding between the two groups (P0. 05), compared with the incidence of postoperative epilepsy, cerebrospinal fluid leakage, bone window hernia, subcutaneous effusion, etc. The dural tension-reduction suture group was superior to the former group (P0.05), and the group with (ADL): Barthel index score more than 20 points was superior to the non-extensional suture group (P0. 05), and the patients with less than 20% score were superior to those with less than 20 points in the subtraction suture group and the non reduction group (P < 0. 05). There was no significant difference in Zhang group (P 0.05). Conclusion: dural tension-reduction suture can effectively reduce the incidence of intracranial hypertension, postoperative epilepsy, cerebrospinal fluid leakage, infection, subcutaneous effusion and bone window hernia, and can effectively improve the prognosis of patients.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651

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