人工硬脑膜和自体筋膜在重型颅脑损伤术中应用对比研究.docVIP

人工硬脑膜和自体筋膜在重型颅脑损伤术中应用对比研究 　　【摘要】 目的：探讨人工硬脑膜在重型颅脑损伤大骨瓣减压术中应用效果。方法：分析2010年1月-2014年6月本院收治的100例颅脑损伤大骨瓣减压术行硬脑膜修补患者的临床资料，其中采用人工硬脑膜修补的患者共50例作为观察组，采用自体膜修补的患者共50例作为对照组。所有患者均于术后3～6个月返院行颅骨修补术。观察并对比两组术后皮下积液、脑膨出、颅内感染及癫痫等并发症发生情况及二期颅骨修补术的手术时间、术中出血量、术后引流量及住院费用。结果：两组的术后颅内感染、脑膨出发生率比较差异无统计学意义（P0.05），观察组术后皮下积液和癫痫发生率明显低于对照组，差异均有统计学意义（P0.05）。观察组住院费用显著高于对照组，两组比较差异有统计学意义（P0.05）。结论：人工硬脑膜安全可靠，能减少术后并发症的发生，并能为二期颅骨修补创造条件，是硬脑膜修补的理想材料，对于经济条件允许的患者首选使用。 　　【关键词】 颅脑损伤； 大骨瓣减压； 硬脑膜修补材料 　　【Abstract】 Objective：To explore the clinical effect of the biological type artificial dura mater applicated in the big bone flap decompression of craniocerebral injury. Method：The clinical data of 100 patients with craniocerebral injury who received the big bone flap decompression dura repaired were given retrospectively analysis from January 2010 to June 2014， 50 patients were adopted the biological type artificial dura repair as observation group， 50 patients were adopted autologous membrane repair as control group. All patients underwent skull repair 3 to 6 months after the decompression surgery. The postoperative complications such as subcutaneous effusion， encephalocele ，intracranial infection and epilepsy，the operation time， intraoperative blood loss ， postoperative flow of the secondary phase skull repair surgery and hospitalization expenses were observed and compared. Result：Compared the incidence of postoperative intracranial infection and encephalocele of the two groups， the difference was statistically significant（P0.05）. The cost of hospitalization in the observation group was significantly higher than that of the control group，the difference was statistically significant（P 　　【Key words】 Craniocerebral injury； Decompression with the large bone flap； Dural repair materials 　　First-author’s address：Feicheng Mining Central Hospital of Shandong，Feicheng 271608，China 　　doi：10.3969/j.issn.1674-4985.2015.25.022 　　大骨瓣减压手术可以有效地降低颅脑损伤患者的颅内压，在去除骨瓣之后，人为的敞开硬脑膜释放脑组织的压力[1]。以往手术常直接旷置敞开的硬脑膜不予缝合，此方法虽然减压充分但却带来了脑脊液瘘、皮下