改良大骨瓣开颅术辅的助选择性压低温救治重型颅脑损伤的疗效对照研究.docVIP

改良大骨瓣开颅术辅助选择性亚低温 救治重型颅脑损伤的疗效对照研究 沈家安，杨涛，权天龙，陈仕明，金涛　扬帆　汪文清 (陕西省安康市中心医院神经外科 陕西安康 725000) [摘要] 目的 探讨改良大骨瓣开颅术辅助选择性亚低温救治重型颅脑损伤的疗效。方法 将268例重型颅脑损伤病人随机分为3组：行改良大骨瓣开颅术辅助选择性亚低温治疗（联合治疗组）92例；改良大骨瓣开颅术常规治疗（改良手术组）87例；标准外伤大骨瓣开颅术常规治疗（标准手术组）89例。根据Glasgow预后评分（GOS）评价病人预后。结果 术后随访1－6个月，平均3个月。联合治疗组恢复良好率为66%，与改良手术组和标准手术组比较，具有显著性差异（p0.01） ；联合治疗组重残率9%，低于标准手术组（p0.05 ）；联合治疗组死亡率25%，与改良手术组和标准手术组比较，具有统计学意义（p0.05 ）。结论 改良大骨瓣开颅术可降低重型颅脑损伤的死亡率；选择性亚低温治疗具有脑保护功能，加快神经功能恢复，提高其恢复良好率；改良大骨瓣开颅术辅助选择性亚低温脑保护的联合治疗，是降低重型颅脑损伤病人死亡率、重残率，提高患者生存质量的有效措施。 [关键词] 重型颅脑损伤；改良大骨瓣开颅术；选择性亚低温 Cotrolled study of clinical effects of modified large craniotomy with selective mild hypothermia treating severe traumatic brain injured patients SHEN Jia-an，YANG Tao，QUAN Tian-long，CHEN Shi-ming，JING Tao （Department of Neurosurgery， Ankang Central Hospital，Ankang 725000，China） Abstract Objective To discuss curative effect of modified large craniotomy with selective mild hypothermia treating severe traumatic brain injured patients. Method Dividing 268 cases of severe traumatic brain injured patients into 3 group： modified large craniotomy with selective mild hypothermia group(n=92)；modified large craniotomy group(n=87)；standard large traumatic craniotomy group(n=89). According to Glasgow Outcome Scale evalute the patients’ prognosis .Results Follow-up from 1 month to 6 months，average 3 months.Good recovery rate of modified large craniotomy with selective mild hypothermia group is 66%，which is higner than modified large craniotomy group and standard large traumatic craniotomy group(P0.01). Severe deficit rate of modified large craniotomy with selective mild hypothermia group is 9%，which is lower than standard large traumatic craniotomy group(P0.05). Death rate of modified large craniotomy with selective mild hypothermia group is 25%，which is lower than modified large craniotomy group and standard large traumatic craniotomy group(P0.05). Conclusion Modified large craniotomy can lower death rate of severe traumatic brain injured pat