高原地区91例重型颅脑损伤不同治疗方法疗效分析

Efficacy of different treatment methods for severe brain injury in plateau area: an analysis of 91 cases

摘要:

目的 探讨高原地区急性颅脑损伤不同治疗方法,特别是不同手术方式的疗效,提高临床治疗水平.方法 分析本院 2002年12月至2012年 12 月收治的91例急性重型颅脑损伤患者,根据采用的新式治疗方案,尤其是标准大骨瓣减压术的时间,91例患者分为两组:早期组(48例,2006年前),后期组(43例,2006年后),对比早期组与后期组不同治疗方法效果总结临床治疗方法.结果 术后早期组1、3、7、15 d GCS评分均低于后期组(P<0.05);术后15 d内早期组死亡18例,后期组死亡7例,早期组死亡率高于后期组(P<0.05);术后15 d内早期组发生大面积脑梗塞10例,而后期组2例,早期组发生大面积脑梗塞率高于后期组(P<0.05);6月良好功能恢复率后期组高于早期组(P<0.05).结论 高原地区急性重型颅脑损伤患者采用标准大骨瓣减压术式,可以降低致死率、脑梗率和提高功能恢复良好率.

Abstract:

Objective To evaluate and improve the clinical outcome of acute brain injury in the plateau area after different treatments, particularly various surgical procedures.Methods We retrospectively analyzed data from 91 patients with acute severe brain injury who were admitted to our institution between December 2002 and December 2012. Based on when new treatment methods, especially large craniotomy, were performed, patients were retrospectively divided into early group (n=48, before the year of 2006) and late group (n=43, after the year of 2006). Differences in the clinical outcome between groups were analyzed.Results Glasgow Coma Scale scores on postoperative days 1, 3, 7, and 15 were significantly lower in the early group than in the late group (P<0.05). Within 15 days after treatment, a higher death rate was observed in the early group than in the late group (18/48 vs 7/43, P<0.05); furthermore, more patients in the early group experienced massive cerebral infarction (10/48 vs 2/43, P<0.05). Within 6 months after treatment, a higher rate of functional recovery was observed in the late group (P<0.05). Conclusions For patients with acute severe brain injury in the plateau area, new treatment methods including large craniotomy can reduce the risk of death and cerebral infarction and offer them a good chance of functional recovery.