分步控制性减压术治疗重型脑外伤的临床应用

Clinical application of gradual controlled decompression in treatment of severe brain trauma

摘要:

目的 探讨分步控制性减压手术在重型脑外伤患者急诊手术中的临床疗效。方法 回顾2012~2014年我院收治的重型脑外伤手术患者50例, 按照手术方式分为两组, 对照组(21例)常规急诊行开颅血肿清除及去骨瓣减压术;治疗组(29例)开颅术中行分步控制性减压。术后随访6个月, GOS评分1~3分为预后不良, GOS评分4~5分为预后良好。结果 对照组发生术中急性脑膨出7例, 迟发伤侧脑内血肿8例, 迟发对侧或枕部硬膜外血肿4例, 术后脑梗死6例。治疗组中发生术中急性脑膨出6例, 迟发伤侧脑内血肿5例, 迟发对侧或枕部硬膜外血肿3例, 术后脑梗死9例。两组对比, 术中急性脑膨出和迟发伤侧脑内血肿、迟发对侧或枕部硬膜外血肿的发生率差异有统计学意义(P<0.05), 术后脑梗死发生率差异无统计学意义(P>0.05)。所有病例随访6个月, 其中对照组GOS评分1~3分11例, 评分4~5分10例;治疗组GOS评分1~3分10例, 评分4~5分19例;两组对比, 预后不良率及良好率差异有统计学意义(P<0.05)。结论 在重型脑外伤患者开颅术中采用分步控制性减压能有效降低术中及术后并发症, 降低死亡率和重残率, 改善预后。

Abstract:

Objective To investigate the clinical efficacy of gradual controlled decompression in emergency surgery for severe brain trauma.Methods The clinical data of 50 patients with severe brain injury who underwent surgery at our hospital from 2012 to 2014 were retrospectively analyzed. The patients were divided into control group (n=21, conventional craniotomy and decompressive craniectomy) and treatment group (n=29, gradual controlled decompression) depending on what surgical procedure was used. The patients were followed up for 6 months. Poor prognosis was defined as a Glasgow Outcome Scale (GOS) score of 1 to 3 and favorable prognosis was defined as a GOS score of 4 to 5.Results In the control group, intraoperative acute encephalocele occurred in 7 patients, delayed ipsilateral brain hematoma in 8 patients, delayed contralateral brain hematoma or occipital epidural hematoma in 4 patients, and postoperative cerebral infarction in 6 patients. In the treatment group, intraoperative acute encephalocele occurred in 6 patients, delayed ipsilateral brain hematoma in 5 patients, delayed contralateral brain hematoma or occipital epidural hematoma in 3 patients, and postoperative cerebral infarction in 9 patients. Significant differences were found in the incidence of intraoperative acute encephalocele, delayed ipsilateral brain hematoma, and delayed contralateral brain hematoma or occipital epidural hematoma between the two groups (P<0.05). However, there was no significant difference in the incidence of postoperative cerebral infarction between the two groups (P >0.05). At the six-month follow-up, there were 11 patients with a GOS score of 1 to 3 and 10 patients with a GOS score of 4 to 5 in the control group, and 10 patients with a GOS score of 1 to 3 and 19 patients with a GOS score of 4 to 5 in the treatment group. Significant differences were noted in poor and favorable prognosis rates between the two groups (P<0.05).Conclusions Gradual controlled decompression in craniotomy can effectively reduce intraoperative and postoperative complications, decrease the rates of mortality and severe disabilities, and improve the prognosis for patients with severe brain trauma.