改良过渡性关颅对颅脑损伤术中急性脑膨出的疗效分析.docVIP

精品论文 参考文献 改良过渡性关颅对颅脑损伤术中急性脑膨出的疗效分析 朱颂华 陆泳宇 朱为民 　　（海门市人民医院脑外科 江苏 海门 226100） 　　【摘要】 目的：探讨改良过渡性关颅法在颅脑损伤术中急性脑膨出患者中的应用效果。方法：选取2010年1月至2013年12月在我院神经外科就诊的术中出现急性脑膨出的颅脑损伤患者40例的临床资料，随机分为改良组和传统组，改良组21例采用改良过渡性关颅方法暂时闭合颅腔，急诊行头颅CT后继续手术治疗，传统组19例采用传统方法强制关颅，查头颅CT明确诊断后再次行手术治疗。比较两组患者的预后情况、内减压发生率及二次手术与脑膨出间隔时间。结果：改良组脑叶切除内减压3例(14.3％)，传统组8例(42.1％)，改良组比例明显低于传统组；改良组二次手术与急性脑膨出间隔时间为36.7plusmn;6.6min，传统组为81.5plusmn;13.1min，改良组明显短于传统组；改良组GCS评分4～5分7例(33.3％)，GCS2～3分11例(50.8％)，传统组GCS评分4～5分4例(21.1％)，GCS2～3分7例(36.8％)，改良组均明显高于传统组；改良组GCS评分为1分的3例(14.3％)，传统组GCS评分为1分的8例(42.1％)。改良组比例明显低于传统组；改良组存活率85.7％（18/21）明显高于传统组57.9％（11/19)。两组患者以上差异均有统计学意义（Plt;0.05）。结论：采用改良过渡性关颅方法暂时关颅后复查头颅CT，根椐CT检查结果合理选择手术方案与颅脑损伤术中急性脑膨出患者的预后关系密切，改良过渡性关颅方法有利于缩短两次手术间隔时间，减少二次脑疝持续时间，对脑组织的保护更好，值得在临床工作中推广。 　　【关键词】 颅脑损伤；急性脑膨出；过渡性关颅方法 　　【中图分类号】R651 【文献标识码】A 【文章编号】2095-1752（2015）16-0208-03 　　Preliminary study on the modified scalp closure method using in acute intraoperative encephalocele 　　Zhu Song-hua,Lu Yongyu,Zhu Weimin Brain Surgery Section, Peoplersquo;s Hospital of Haimen, Jiangsu Haimen 226100 China 　　【Abstract】Objective To investigate the suitable management on acute intraoperative encephalocele in head injury patients．Methods 40 cases with acute intraoperative encephalocele in craniocerebral injury from Jan 2010 to Dec 2013 were analyzed retrospectively．The incidence of 1obe resection was analyzed and the outcomes after 3 months were assessed by using Gllasgow outcome score(GCS)among 21 patients treated by using the modified scalp closure method and 19 patients treated by the traditional closure method．Results The incidence of lobe resection was significantly reduced by using modified scalp closure method compared with the traditional method after operation(Plt;0.05)．There was significant differenee in GCS after 3 months between 2 groups(Plt;0.05)．Conclusions According to intraoperative findings of CT，the reasonable treatment was the key factor to improve the outcomes of the patients of a