早期不同时点加压包扎预防去骨瓣减压术后硬膜下积液临床研究

Clinical effect of pressure dressing at different time points for the prevention of subdural effusion after decompressive craniectomy

摘要:

目的 评价开颅去骨瓣减压(DC)术后不同时点加压包扎预防硬膜下积液的疗效。方法 选择2014年10月~2015年9月在我院接受DC手术的患者77例,按随机数字表分为早期组37例和晚期组40例,分别在DC术后第3 d和第7~10 d对骨窗进行加压包扎,直至颅脑组织恢复至正常解剖位置,评价两组硬膜下积液的发生率和临床预后。结果 早期组和晚期组分别有3例和5例患者死亡,但总体GOS评分和住院时间组间比较差异无统计学意义(P>0.05);两组分别有17例和8例患者出现硬膜下积液,晚期组发生率低于早期组(P<0.05);治疗后两组颅内压(ICP)均有一定程度下降,但组间比较差异无统计学意义(P>0.05)。结论 DC术后第7~10 d加压包扎有助于预防硬膜下积液的形成,但对临床预后无明显影响。

Abstract:

Objective To investigate the clinical effect of pressure dressing at different time points for the prevention of subdural effusion after decompressive craniectomy (DC).Methods A total of 77 patients who underwent DC in our hospital from October 2014 to September 2015 were selected and divided into early group (37 patients) and late group (40 patients) according to a random number table. The early group and late group received bone window pressure dressing at 3 and 7-10 days, respectively, after DC, until the brain tissue was restored to the normal anatomical position. The incidence rate of subdural effusion and clinical prognosis were compared between the two groups.Results Three patients in the early group and 5 in the late group died, and the overall score of Glasgow Outcome Scale and length of hospital stay showed no significant differences between the two groups (P>0.05). Seventeen patients in the early group and 8 in the late group experienced subdural effusion, and the late group had a significantly lower incidence rate of subdural effusion than the early group (P<0.05). Both groups experienced a certain degree of reduction in intracranial pressure, which showed no significant difference between the two groups (P>0.05).Conclusions Pressure dressing at 7-10 days after DC helps to prevent subdural effusion, but has no significant effect on clinical prognosis.