[1]徐勇,林爱明,刘佳骐.预见性双侧去骨瓣减压与相继性双侧去骨瓣减压治疗重型颅脑损伤临床疗效的差异性分析[J].临床神经外科杂志,2014,(06):470-472.
　Xu Yong,Lin Aiming,Liu Jia Qi.Clinical features and Surgical treatment of traumatic intracerebral hemorrhage[J].Journal of Clinical Neurosurgery,2014,(06):470-472.
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预见性双侧去骨瓣减压与相继性双侧去骨瓣减压治疗重型颅脑损伤临床疗效的差异性分析
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
期数:
2014年06期
页码:
470-472
栏目:
临床研究
出版日期:
2014-12-31

文章信息/Info

Title:
Clinical features and Surgical treatment of traumatic intracerebral hemorrhage
作者:
徐勇; 林爱明; 刘佳骐
江苏扬中市人民医院
Author(s):
Xu Yong; Lin Aiming; Liu Jia Qi　
Department of Yangzhong People's Hospital of Neurosurgery
关键词:
重型颅脑损伤; 双侧去骨瓣减压; 手术治疗
Keywords:
severe craniocerebral injury;  bilateral decompression craniectomy;  operation
分类号:
R651.1
文献标志码:
D
摘要:
目的：探讨分析预见性双侧去骨瓣减压术与相继性双侧去骨瓣减压术治疗重型颅脑损伤的临床疗效差异，为临床优化治疗方案提供参考。方法：将2008年1月-2013年1月我院收治122例的重型颅脑损伤[格拉斯哥昏迷评分（GCS）3~8分] 患者随机分为2组，62例采用预见性双侧去骨瓣减压术（观察组）；60例采用相继性双侧去骨瓣减压术（对照组）。术后治疗方案基本相同，治疗3个月后患者均行格拉斯哥预后评分（GOS），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：术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（19.4%比46.7%；22.6%比51.7%，P＜0.05）。观察组GOS评分良好率明显高于对照组（38.7%比16.7%，P＜0.05），观察组病死率明显低于对照组（6.5%比25.0%，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）。观察组术后并发症发生率明显低于对照组（24.2%比50.0%，P＜0.05）。结论：预见性双侧去骨瓣减压术用于治疗重型颅脑损伤近期临床疗效优于相继性双侧去骨瓣减压术，可显著改善预后及降低并发症，值得在临床推广应用。
Abstract:
Objective: To investigate the clinical efficacy between the active bilateral decompressive craniectomy and successively bilateral decompression craniectomy in the treatment of severe craniocerebral injury, to provide reference for optimizing clinical therapeutic regimen. Methods 121 patients with severe craniocerebral injury (GOS score from 3-8) treated in the Nanjing Brain Hospital from January 2008 to January 2013 were selected and randomly divided into two groups. 62 patients in observation group and 60 patients in control grou, patients in observation group were treated with active bilateral decompressive craniectomy, and patients in control group were treated with successively bilateral decompression craniectomy. All the patients got the almost same therapeutic methods after operations. 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 incisional hernia of observation group patients were significantly lower than those of control group 19.4%, 46.7% 22.6%, 51.7%, the differences were statistically significant (all< 0.05). GOS good rate of observation groupwas significantly higher than that of control group 38.7% 16.7%, the death rate of observation group was significantly lower than that of control group 6.5% 33.3% , the differences were statistically significant ( < 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 > 0.05). Complication occurrence rate of observation group was lower than that of control group 19.4% 50.0% , the differences were statistically significant (all < 0.05). Conclusion The active bilateral decompressive craniectomy in the treatment of severe craniocerebral injurycan effectively improve the prognosis of patients, and reduce the incidence of postoperative complications. And it is worthy to recommand its clinical application.

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备注/Memo

备注/Memo:
［收稿日期］ 2014-09-25
更新日期/Last Update: 2014-12-15