标准大骨瓣开颅血肿清除对重度颅脑外伤侧裂区损伤致单侧脑肿胀的疗效观察.pdfVIP

· 短 篇 论 著 · 标准大骨瓣开颅血肿清除对重度颅脑外伤侧裂区损伤致 单侧脑肿胀的疗效观察 章 剑 【摘要】 目的 探讨标准大骨瓣开颅血肿清除去大骨瓣减压术对重度颅脑外伤侧裂区损伤致单侧脑肿胀的疗 效。方法 57例重度颅脑外伤侧裂区损伤致单侧脑肿胀患者随机分成观察组 (32例)和对照组 (25例)，分别采用标 准和常规大骨瓣开颅血肿清除术治疗。观察并比较两组患者术后的格拉斯哥评分 (GCS)、颅内压 (ICP)、脑水肿体 积、中线移位情况和生存率。结果 观察组术后3d和7d时评分GCS明显高于对照组，而 ICP、脑水肿体积和中线移 位均明显少于对照组，差异有统计学意义 (P0．05)；术后随访 1年，观察组生存率为75％，明显高于对照组的 48％，差异有统计学意义 ()(2=4．39，P0．05)。结论 标准大骨瓣开颅血肿清除去大骨瓣减压术可以明显改善重度 颅脑外伤侧裂区损伤致单侧脑肿胀患者的预后，降低病死率。 【关键词】 标准大骨瓣开颅；血肿，硬膜下；脑水肿；去大骨瓣减压；侧裂区损伤 【中图分类号】R651．1 【文献标识码】B 【文章编号】1007—9572 (2010)l1—3682—03 EffectivenessofStandardLargeTraumaCraniotomyforHematomaRemovalinTreatingUnilateralBrainSwellingfol- lowingSylvianFissureDamageofSevereBrainInjury ZHANGJian．NeurologicalSurgery，CangnanPeopleSHospital， Cangnan325800，China A【bstract】 0bjective Toexploretheeffectivenessofstandardlargetraumacraniotomyforhematomaremovalintrea— ringunilateralbrainswellingfollowingsylvianfissuredamageofseverebraininjury．Methods Totally57patientswithsevere braininjuryandsylvianfissuredamagewithunilateralbrainwellingwererandomlydividedintoobservationgroup(n=32；re— ceivedstandardlargetraumacraniotomyofrhematomaremova1)andcontrolrgoup(n=25；receivedconventionallargetrauma craniotomyofrhematomaremova1)。GCSscores，intracranialpressure(ICP)，cerebraledemavolume，midlineshift，andsur- vivalratewerecomparedbetweenthesetworgoups．Results The3一dayand7一dayGCSscoresweresignificna tlyhigherand thetheICP，cerebraledemavolume，andmidlineshiftweresingificantlylowerintheobservationrgoupthanincontrolrgoup(all P0．05)．The1一yearsurvivalratewas75％ intheobservationgroup，whichwassingificantlyhigherthanhtat(48％)in controlrgoup()(z=4．39，P0．05)．Conclusion Thestandardlargetraumacraniotomyofrhematomaremovalcaneffectively improvetheprognosisanddecreasethecase—fatalityrateinpatientswithunilateralbrainswellingfollowingsylvianfissuredamage ofseverebraininjury． K【eywords】 Standradlargetraumacraniotomy；Hemat