摘要
目的 探讨双侧去骨瓣减压术对双侧不对称性重型颅脑损伤的临床治疗效果.方法 选择2008年4月～2011年12月浙江省宁波市第一医院收治的双侧不对称性重型颅脑损伤患者61例为研究对象,随机分为观察组31例,对照组30例.观察组采用双侧去骨瓣减压术,对照组采用单侧标准外伤大骨瓣手术.治疗3个月后患者均行格拉斯哥预后（GOS）评估,比较两组患者术中急性脑组织膨出及术后切口疝发生率、GOS评分及并发症情况.结果 ①治疗后,观察组术中急性脑组织膨出、术后切口疝发生率均明显低于对照组（9.7％、50.0％比12.9％、53.3％）,差异均有统计学意义（均P＜ 0.05）.②观察组GOS评价良好率明显高于对照组（38.7％比16.7％）,观察组病死率明显低于对照组（6.5％比33.3％）,差异均有统计学意义（均P＜ 0.05）.观察组中残率、重残率、植物化生存率与对照组比较,差异均无统计学意义（均P＞ 0.05）.③观察组术后并发症发生率明显低于对照组（19.4％比50.0％）,差异有统计学意义（P＜0.05）.结论 双侧去骨瓣减压术治疗双侧不对称性重型颅脑损伤,其术中并发症发生率及病死率较低,治疗效果及术后预后较好,值得临床推广使用.
Objective To investigate the clinical efficacy of bilateral decompressive craniectomy in the treatment of bilat- eral asymmetrical severe cranioeerebral injury. Methods 61 patients with bilateral asymmetrical severe craniocerebral injury treated in the First Hospital of Ningbo City from April 2008 to December 2011 were selected and randomly divided into two groups. 30 patients in control group and 31 patients in observation group, patients in observation group were treated with bilateral decompressive craniectomy, and patients in control group were treated with unilateral standard large trauma craniotomy. The Glasgow outcome score （GOS） of all patients in both groups was evaluated 3 months after treatment, the occurrence rate of intraoperative acute brain tissue bulging and postoperative incision hernia between the two groups were compared; GOS scores and complication were observed. Results After treatment, incidence of acute intraoperative encephalocele and incidence of postoperative ineisional hernia of observation group patients were signifi cantly lower than those of control group （9.7%, 50.0% vs 12.9%, 53.3%）, the differences were statistically significant （all P 〈 0.05）.GOS good rate of observation groupwas significantly higher than that of control group （38.7% vs 16.7%）, the death rate of observation group was significantly lower than that of control group （6.5% vs 33.3% ）, the differences were statistically significant （P 〈 0.05）. The differences of moderate disability rate, severe disability rate, vegetative survival rate of observation group and control group were not statistically significant （all P 〉 0.05）. Complication occurrence rate of observation group was lower than that of control group （19.4% vs 50.0%）, the differences were statistically significant （all P 〈 0.05）. Conclusion Bilateral decompressive craniectomy in the treatment of bilateral asymmetrical severe cranio- cerebral injury patients can significantly improve the clinical effect and prognosis
出处
《中国医药导报》
CAS
2014年第5期50-52,共3页
China Medical Herald
基金
浙江省医学会临床科研基金资助项目(编号Y2011ZYC-A71)
关键词
双侧去骨瓣减压术
单侧标准外伤大骨瓣术
双侧不对称性重型颅脑损伤
Bilateral decompressive craniectomy
Unilateral standard large trauma craniotomy
Bilateral asymmetricalsevere craniocerebral injury
