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月收治的重型颅脑损伤患者284例,按数字随机表法分为试验组和对照组,各142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3、5、7 d检测患者颅内压(intracranial pressure,ICP),于术后6个月时采格拉斯哥预后评分(Glasgow prognosis score,GPS)评估2组患者预后情况,详细记录2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3、5、7 d ICP值均明显低于对照组,差异具有统计学意义(P<0.05);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59.86%(85/142)、33.80%(48/142)、6.34%(9/142),对照组患者分别为39.43%(56/142)、50.00%(71/142)、10.56%(15/142),2组患者术后预后情况差异有统计学意义(P<0.05);与对照组比较,试验组术后脑水肿发生率明显降低,脑水肿程度也明显减轻,差异均有统计学意义(P<0.05);与对照组比较,试验组术后脑梗死发生率明显降低,且梗死体积也明显缩小,差异均有统计学意义(P<0.05)。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。
Objective To investigate the effect of continuous lumbar drainage combined with decompressive craniectomy on complications and prognosis of patients with severe craniocerebral injury in order to provide reference for optimization of surgical treatment of these patients. Methods Two hundred and eighty-four cases of patients with severe craniocerebral injury admitted to our hospital between February 2013 and April 2016 were selected and randomly divided into the experimental group and control group, with 142 cases in each. Patients in the control group received decompressive craniectomy treatment, while those in the experimental group additionally received continuous lumbar drainage. The int racranial pressu re（ICP） was detected at 3, 5, 7 d af ter su rger y, and the prog nosis was evaluated by the Glasgow Prognostic Score（GPS） 6 months after operation. The incidence of hydrocephalus and cerebral infarction was recorded in detail. Results The ICP of the experimental group was significantly lower than that of the control group at 3, 5 d and 7 d after operation（P〈0.05）. Six months after operation, the rate of good prognosis, poor prognosis and mortality of the experimental group were 59.86%（85/142）, 33.80%（48/142） and 6.34%（9/142） respectively, compared with 39.43%（56/142）, 50.00%（71/142）, and 10.56%（15/142） in the control group, so there was statistically significant difference between the two groups（P〈0.05）. Compared with the control group, the incidence of brain edema and severity of edema in the experimental group were significantly decreased（P〈0.05）, so were the incidence of cerebral infarction and the infarct volume in the experimental group（P〈0.05）. Conclusion Continuous lumbar drainage combined with decompressive craniectomy is better than decompressive craniectomy alone in that this approach is effective in treating severe craniocerebral injur y, alleviating the ICP, improving prognosis and reducing the incidence of postoperative complications.
作者
李欣
LI Xin(Department of Neurosurgery, Xianyang Hospital of Yan＇an University, Yan＇an Shanxi 712000, China)
出处
《空军医学杂志》
2018年第2期101-103,122,共4页
Medical Journal of Air Force
关键词
重型颅脑损伤
骨瓣减压控制术
腰大池持续引流术
预后
并发症
severe craniocerebral injury
decompressive craniectomy
continuous lumbar drainage
prognosis
complications
