摘要
目的探究双侧去骨瓣、单侧大骨瓣减压术在对冲型重型颅脑损伤患者治疗过程中的应用效果差异。方法研究对象选取2017年8月至2020年10月商丘市长征人民医院收治的82例对冲型重型颅脑损伤患者,随机分为双侧组和单侧组,各41例,双侧组患者采用双侧去骨瓣减压术治疗,单侧组患者采用单侧大骨瓣减压术治疗。两组患者围术期干预方案相同。比较两组患者术前及术后7 d的颅内压状况、格拉斯哥昏迷(GCS)量表评分、脑部氧代谢相关指标[颈内静脉氧含量(CjvO_(2))、动脉-颈内静脉球部血氧差(Da-jvO_(2))],比较两组患者的治疗效果,比较两组患者的手术并发症情况(脑脊液漏,颅内感染,外伤性癫痫,颅内再出血)。结果在手术前,两组患者的颅内压、GCS评分、CjvO_(2)、Da-jvO_(2)的数据比较,差异均无统计学意义(P>0.05)。在术后7 d,两组患者的颅内压、Da-jvO_(2)均低于术前,GCS评分、CjvO_(2)均高于术前,差异均具有统计学意义(P<0.05)。在术后7 d,双侧组患者的颅内压、Da-jvO_(2)低于单侧组患者,双侧组患者的GCS评分、CjvO_(2)高于单侧组患者,差异均具有统计学意义(P<0.05)。双侧组患者的治疗效果优于单侧组患者,差异有统计学意义(P<0.05)。双侧组患者的并发症发生率[7.32%(3/41)]显著低于单侧组患者[34.15%(14/41)],差异有统计学意义(P<0.05)。结论与单侧大骨瓣减压术相比,双侧去骨瓣减压术治疗对冲型重型颅脑损伤患者的临床效果更优,可有效降低患者手术之后的颅内压,改善患者的GCS评分及脑部氧代谢情况,且术后并发症更少,值得临床应用。
Objective To explore the difference in the application effect of bilateral decompressive craniectomy and unilateral large craniectomy in the treatment of patients with contrecoup severe brain injury.Methods A total of 82 patients with contrecoup severe brain injury treated at Changzheng People's Hospital in Shangqiu City from August 2017 to October 2020 were selected as the study subjects.They were randomly divided into bilateral group and unilateral group,with 41 cases in each group.Patients in the bilateral group received bilateral decompressive craniectomy,while patients in the unilateral group received unilateral large craniectomy.The perioperative intervention plan is the same for both groups of patients.The intracranial pressure status,Glasgow Coma Scale(GCS)score,and brain oxygen metabolism related indicators[cerebral jugular venous oxygen content(CjvO_(2))and difference of arterio-jugular venous oxygen content(Da-jvO_(2))]of two groups of patients were compared before and 7 days after surgery,and the treatment effect of the two groups of patients was compared.The surgical complications(cerebrospinal fluid leakage,intracranial infection,traumatic epilepsy,and intracranial rebleeding)of the two groups of patients were compared.Results Before surgery,there was no statistically significant difference in intracranial pressure,GCS score,CjvO_(2),and Da-jvO_(2) between the two groups of patients(P>0.05).At 7 days after surgery,the intracranial pressure and Da-jvO_(2) of both groups of patients were lower than those before surgery,while the GCS score and CjvO_(2) were higher than those before surgery,and the differences were statistically significant(P<0.05).At 7 days after surgery,the intracranial pressure and Da-jvO_(2) of patients in the bilateral group were lower than those in the unilateral group,and the GCS score and CjvO_(2) of patients in the bilateral group were higher than those in the unilateral group,with statistical significance(P<0.05).The treatment effect of patients in the bilateral group was better than that of patients in the unilateral group,and the difference was statistically significant(P<0.05).The incidence of complications in bilateral group patients[7.32%(3/41)]was significantly lower than that in unilateral group patients[34.15%(14/41)],and the difference was statistically significant(P<0.05).Conclusion Compared with unilateral decompressive craniectomy,bilateral decompressive craniectomy has a better clinical effect in the treatment of patients with contrecoup severe brain injury.It can effectively reduce postoperative intracranial pressure,improve GCS score and brain oxygen metabolism,and has fewer postoperative complications,making it worthy of clinical application.
作者
朱伟
ZHU Wei(Department of Neurosurgery,Changzheng People's Hospital,Shangqiu City,Shangqiu Henan 476002,China)
出处
《临床研究》
2024年第2期53-55,共3页
Clinical Research
关键词
对冲型重型颅脑损伤
双侧去骨瓣减压术
单侧大骨瓣减压术
颅内压
contrecoup severe brain injury
bilateral decompressive craniectomy
unilateral large craniectomy
intracranial pressure
作者简介
朱伟,男,主治医师,本科。研究方向:神经外科学。
