摘要
目的探讨去骨瓣减压联合脑基底池置管引流治疗脑挫裂伤并蛛网膜下腔出血的效果。方法选取2012年10月-2016年9月我院神经外科收治的76例各种创伤引起的严重脑挫裂伤合并蛛网膜下腔出血的患者为研究对象,按照随机数字表法分为观察组和对照组,每组各38例,对照组患者行常规去骨瓣减压+药物治疗,观察组患者在对照组基础上进行脑基底池置管引流治疗,观察比较两组患者术后第7、8、9天脑脊液中红细胞计数和蛋白质含量,术后蛛网膜下腔出血消散时间,术后半年GCS评分,术后脑血管痉挛程度,术后半年脑积水及术后颅内感染发生率。结果治疗后两组患者脑脊液中红细胞计数和蛋白质含量随时间增长逐渐降低,且观察组患者在相同时间点的脑脊液中红细胞计数和蛋白质含量显著低于对照组(P<0.05)。观察组患者术后蛛网膜下腔出血消散时间低于对照组(P<0.05),而术后半年GCS评分高于对照组(P<0.05)。观察组术后脑血管痉挛发生率(71.05%)显著低于对照组(92.10%)(P<0.05),而半年内脑积水发生率(5.26%)显著低于对照组(26.32%)(P<0.05),但两组患者在术后颅内感染比较差异不显著(P>0.05)。结论去骨瓣减压联合脑基底池置管引流治疗脑挫裂伤并蛛网膜下腔出血能够充分引流脑脊液,减少脑血管痉挛和降低术后脑积水发生率,减少颅内并发症,值得临床推广使用。
Objective To explore the effects of decompressive craniectomy combined with cerebral basilar cistern drainage in the treatment of cerebral contusion and laceration with subarachnoid hemorrhage. Methods Seventy-six patients with severe cerebral contusion and subarachnoid hemorrhage caused by traumas treated in our hospital between October 2012 and September 2016 were selected as subjects and divided into the observations group and the control group according to the random number table method,with 38 cases in each group. The patients in the control group were treated with conventional decompressive craniectomy and medication,while those in the observation group were additionally given brain basilar cistern drainage. The erythrocyte count and protein content of the cerebrospinal fluid on the 7 th,8 th and 9 th day after operation,the dissipation time of postoperative subarachnoid hemorrhage,the GCS score six months after operation,the postoperative cerebral vasospasm degree,hydrocephalus six months after operation and the incidence of postoperative intracranial infections were observed and compared between the two groups. Results After treatment,erythrocyte count and protein content in the cerebrospinal fluid gradually decreased with the passage of time in the two groups,and they were significantly lower in the observation group than in the control group at the same time points（ P〈0. 05）. The dissipation time of subarachnoid hemorrhage was significantly shorter in the observation group than that in the control group（ P〈0. 05）,while the GCS score six months after operation was significantly higher than that of the control group（ P〈0. 05）. The incidence of postoperative cerebral vasospasm was significantly lower in the observation group（ 71. 05%） than that in the control group（ 92. 10%）（ P〈0. 05）,the incidence of hydrocephalus within six months was significantlylower in the observation group（ 5. 26%） than that of the control group（ 26. 32%）（ P〈0. 05）,but there was no signi
作者
金卫星
祝斐
陈进
汪勇军
路遥
JIN Weixing;ZHU Fei;CHEN Jin;WANG Yongjun;LU Yao(Department of Neurological Surgery,No.171 Hospital of PLA,Jiujiang 332000,China)
出处
《解放军预防医学杂志》
CAS
2018年第6期724-728,共5页
Journal of Preventive Medicine of Chinese People's Liberation Army
基金
南京军区重点课题(No.2011z019)
关键词
去骨瓣减压
脑基底池置管引流
脑挫裂伤
蛛网膜下腔出血
decompressive craniectomy
cerebral basilar cistern drainage
cerebral contusion and laceration
subarachnoid hemorrhage
