摘要
目的探讨颅内压(ICP)监测下控制性减压联合预缝式关颅在重型颅脑损伤(sTBI)患者手术中的应用价值。方法收集2017年1月至2019年9月湖州市第一人民医院(湖州师范学院附属第一医院)神经外科收治的sTBI患者136例,其中2018年2月及以前收治的患者57例(对照组)术中均采取ICP监测下常规快速血肿清除及标准去大骨瓣减压手术治疗(未采取控制性减压),2018年3月收治后的患者79例(研究组)术中均采取ICP监测下控制性减压联合预缝式关颅手术。对2组患者的术中低血压、急性脑膨出、迟发性颅内血肿等并发症的发生率、脑组织暴露时间、关颅时间、颅骨去骨瓣情况、非计划再次手术及伤后6个月的GOS评分进行回顾性对比分析研究,明确ICP监测下控制性减压联合预缝式关颅这种手术模式在救治中的效果。结果2组患者的性别分布、年龄、受伤至手术时间、术前GCS评分、术前瞳孔散大、影像学资料及初始ICP等比较差异均无统计学意义(P>0.05)。研究组术中低血压、急性脑膨出及迟发性颅内血肿的发生率较对照组低,脑组织暴露时间及关颅时间较对照组短,双侧颅骨去骨瓣率较对照组低,非计划再次手术率较对照组低,预后良好率较对照组明显提高,死亡率较对照组明显降低,差异均有统计学意义(P<0.05)。结论ICP监测下控制性减压联合预缝式关颅模式的应用能降低sTBI患者术中低血压、急性脑膨出及迟发性颅内血肿的发生率,能降低患者非计划再次手术率或双侧颅骨去骨瓣率,改善患者的预后。
Objective To investigate the application value of controlled decompression combined with pre suture craniotomy under intracranial pressure(ICP)monitoring in patients with severe traumatic brain injury(sTBI).Methods One hundred and thirty-six patients with sTBI admitted to Neurosurgery Department of The First People’s Hospital of Huzhou(the First Affiliated Hospital of Huzhou Normal University)from January 2017 to September 2019 were collected.Among them,57 patients before February 2018(control group)were treated with routine rapid hematoma clearance and standard large bone flap decompression surgery(without controlled decompression)under ICP monitoring,and 79 patients after March 2018(study group),controlled decompression under ICP monitoring combined with pre suture craniotomy was adopted.The incidence of intraoperative hypotension,acute encephalocele,delayed intracranial hematoma and other complications,brain tissue exposure time,craniotomy time,unplanned reoperation and GOS score at 6 months after injury were retrospectively analyzed and compared between the two groups.It was clear that the operation mode of controlled decompression combined with presplitting craniotomy under ICP monitoring was effective in the treatment.Results There were no significant differences in gender distribution,age,injury to operation time,preoperative GCS score,preoperative mydriasis,imaging data and initial ICP between the two groups(P>0.05).The incidences of intraoperative hypotension,acute encephalocele and delayed intracranial hematoma in the study group were lower than those in the control group,the exposure time and closing time of brain tissue were shorter than those of the control group,the removal rate of bilateral cranial bone flap was lower than that of the control group,the unplanned reoperation rate was lower than that of the control group,the good prognosis rate was significantly higher than that of the control group,and the mortality rate was significantly lower than that of the control group(all P<0.05).Conclusion
作者
阳建国
钟兴明
吴利平
Yang Jianguo;Zhong Xingming;Wu Liping(Department of Neurosurgery,The First People’s Hospital of Huzhou(The First Affiliated Hospital of Huzhou Normal University),Huzhou 313000,China)
出处
《中华神经创伤外科电子杂志》
2020年第5期265-269,共5页
Chinese Journal Of Neurotraumatic Surgery：Electronic Edition
基金
浙江省医药卫生科技计划项目(2019KY678)
浙江省湖州市科技计划项目(2018GYB64)。
关键词
重型颅脑损伤
控制性减压
预缝式关颅
颅内压监测
Severe traumatic brain injury
Controlled decompression
Anterior closure
Intracranial pressure
