摘要
目的:探究阶梯减压在去骨瓣减压术中的价值。方法:选取2017年8月—2020年2月武警总队医院收治的81例重型颅脑损伤患者作为研究对象,均行去骨瓣减压术,其中40例患者采用常规减压为对照组,另41例患者采用阶梯减压为观察组,比较两组患者术中失血量、手术时间、住院时间、围术期并发症、术后颅内压、术前及术后1个月神经功能缺损情况(NIHSS)、日常生活能力(ADL)、血清脑损伤指标[胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)]水平、预后改善情况。结果:与对照组比较,观察组术中失血量明显减少,手术时间、住院时间明显缩短,差异有统计学意义(t=5.410、8.994、6.454,P<0.05)。观察组围手术期迟发性血肿、急性脑膨出、术后脑梗死发生率均低于对照组,差异有统计学意义(χ^(2)=4.225、5.357、4.669,P<0.05)。观察组术后第1d、第3d、第5d颅内压均较对照组低,差异有统计学意义(t=16.092、16.956、14.515,P<0.05);术后1个月观察组NIHSS评分低于对照组,ADL评分高于对照组,差异有统计学意义(t=12.255、6.639,P<0.05);术后1个月观察组血清GFAP、NSE水平均低于对照组,差异有统计学意义(t=3.570、3.320,P<0.05);观察组预后改善情况优于对照组,差异有统计学意义(u=2.771,P<0.05)。结论:阶梯减压应用于去骨瓣减压术,可有效、平稳降低重型颅脑损伤患者颅内压,预防围手术期并发症,有效减轻脑损伤,促进术后恢复,改善预后。
Objective:To explore the value of stepped decompression in decompressive craniectomy.Methods:A total of 81patients with severe craniocerebral injury in the hospital from August 2017 to February 2020 were selected as the research objects and underwent decompressive craniectomy.40 patients treated with conventional decompression were selected as the control group,and the other 41 patients treated with stepped decompression were as selected observation.Intraoperative blood loss,operative time,hospital stay,perioperative complications,postoperative intracranial pressure,preoperative and 1 month postoperative neurological deficit(NIHSS),activities of daily living(ADL),serum brain injury indicators(glial fibrillary acidic protein[GFAP],neuronspecific enolase[NSE])levels,and prognosis improvement were compared between the two groups.Results:Compared with the control group,the intraoperative blood loss in the observation group was significantly reduced,and the operation time and hospitalization time were significantly shortened,and the differences were statistically significant(t=5.410,8.994,6.454,P<0.05).The incidences of delayed hematoma,acute encephalocele and postoperative cerebral infarction in the observation group were lower than those in the control group,and the differences were statistically significant(χ^(2)=4.225,5.357,4.669,P<0.05).The intracranial pressure of the observation group was lower than that of the control group on the 1st,3rd,and 5th days after operation,the difference was statistically significant(t=16.092,16.956,14.515,P<0.05).1 month after operation,the NIHSS score of the observation group was lower than that of the control group,and the ADL score was higher than that of the control group,the difference was statistically significant(t=12.255,6.639,P<0.05).1 month after operation,the serum GFAP and NSE levels in the observation group were lower than those in the control group,the difference was statistically significant(t=4.570,3.320,P<0.05).The prognosis improvement of the observation group wa
作者
冯金勇
FENG Jin-yong(The First Department of Spine Surgery,Armed Police Corps Hospital,Zhengzhou,Henan,450003,China)
出处
《黑龙江医学》
2022年第12期1452-1454,共3页
Heilongjiang Medical Journal
关键词
重型颅脑损伤
去骨瓣减压术
阶梯减压式
Severe craniocerebral injury
Decompressive craniectomy
Stepped decompression
