摘要
目的观察逐步减压术治疗重型颅脑损伤的临床疗效及其对患者颅内压的改善作用。方法回顾性分析太原钢铁(集团)有限公司总医院2015年1月至2020年1月收治的重型颅脑损伤患者120例的临床资料,根据不同治疗方法分组,接受传统去骨瓣减压术治疗的患者64例为对照组,接受逐步减压术治疗的患者56例为逐步减压组,比较两组患者治疗各时间点(术前、术中、术后即刻、术后3个月、术后6个月)颅内压,评估术前及术后6个月患者生活自理能力、昏迷程度、神经功能缺损情况,统计术中及术后6个月内并发症发生情况并进行生活质量评估。结果术前,两组颅内压差异无统计学意义(P>0.05),术中、术后即刻、术后3个月、术后6个月逐步减压组颅内压分别为(30.74±2.51)mmHg、(25.11±2.06)mmHg、(21.34±2.01)mmHg、(16.74±1.54)mmHg,均明显低于对照组的(34.31±3.06)mmHg、(30.64±2.57)mmHg、(26.33±2.35)mmHg、(22.64±1.95)mmHg(t=12.88、19.03、12.40、18.20,均P<0.001)。术前,两组改良巴氏指数评定量表(MBI)、格拉斯哥昏迷评分法(GCS)、美国国立卫生研究院卒中量表(NIHSS)评分差异均无统计学意义(均P>0.05),术后6个月两组MBI及GCS评分均上升,NIHSS均下降,两组术后6个月NIHSS、MBI、GCS评分差异均有统计学意义(t=7.61、6.26、13.07,均P<0.001)。术中及术后6个月,逐步减压组脑梗死、迟发性脑血肿、急性脑膨出发生率均明显低于对照组(χ^(2)=4.23、4.35、4.83,均P<0.05)。生活质量综合问卷(GQOLI-74)多维度评估显示,逐步减压组4个维度(物质、躯体、社会、心理)评分均显著高于对照组,差异均有统计学意义(t=8.16、9.80、8.68、7.76,均P<0.001)。结论该研究首次从患者颅内压、生活质量、术后短中期并发症等多个方面分析逐步减压术用于重型颅脑损伤治疗的可行性,证实重型颅脑损伤患者接受逐步减压术治疗可有效降低患者颅内压,改善其神经功能,预防并发症,同时提高患者生活自理能力及生活质量。
Objective To investigate the clinical efficacy of gradual decompression in the treatment of severe traumatic brain injury and its effects on the improvement of intracranial pressure.Methods The clinical data of 120 patients with severe traumatic brain injury who received treatment in the General Hospital of Taiyuan Iron and Steel(Group)Co.,Ltd.from January 2015 to January 2020 were retrospectively analyzed.The included patients were divided into decompressive craniectomy group(control group,n=64)and gradual decompression group(n=56).Intracranial pressure was compared between the two groups at different time points(before surgery,during the surgery,immediately after surgery,3 and 6 months after surgery).The patient's self-care ability,coma degree,and neurological deficits pre-surgery and 6 months after surgery were evaluated in each group.The incidence of complications throughout the surgery and within 6 months after surgery was calculated to evaluate the quality of life.Results There was no significant difference in intracranial pressure pre-surgery between the two groups(P>0.05).Intracranial pressure in the gradual decompression group was(30.74±2.51)mmHg,(25.11±2.06)mmHg,(21.34±2.01)mmHg,and(16.74±1.54)mmHg respectively during the surgery,immediately after surgery,and 3 and 6 months after surgery,which was significantly lower than that in the control group[(34.31±3.06)mmHg,(30.64±2.57)mmHg,(26.33±2.35)mmHg,(22.64±1.95)mmHg,t=12.88,19.03,12.40,18.20,all P<0.001].There were no significant differences in scores of the Modified Barthel Index(MBI),the Glasgow Coma Scale(GCS),the National Institutes of Health Stroke Scale(NIHSS)pre-surgery between the two groups(all P>0.05).At 6 months after surgery,the MBI and GCS scores increased and the NIHSS score decreased in each group.There were significant differences in the NIHSS,MBI,and GCS scores between the two groups(t=7.61,6.26,13.07,all P<0.001).During the surgery and 6 months after surgery,the incidences of cerebral infarction,delayed cerebral hematoma,and acute encephalocele were significantly lower in the gradual decompression group than in the control group(χ^(2)=4.23,4.35,4.83,all P<0.05).The Generic Quality of Life Inventory-74 Questionnaire scores in environment,psychological health,social relationship,and psychological health domains were significantly higher in the gradual decompression group than in the control group(t=8.16,9.80,8.68,7.76,all P<0.001)Conclusion This study is the first to analyze the feasibility of gradual decompression for the treatment of severe traumatic brain injury in terms of intracranial pressure,quality of life,and short-and medium-term complications.Findings from this study confirm that gradual decompression can effectively lower intracranial pressure of patients with severe traumatic brain injury,improve neurological function,reduce complications,and improve patients'self-care ability and quality of life.
作者
郭涛
芦戬
张瑞生
Guo Tao;Lu Jian;Zhang Ruisheng(Department of Neurosurgery,General Hospital of Taiyuan Iron and Steel(Group)Co.,Ltd.,Taiyuan 030003,Shanxi Province,China)
出处
《中国基层医药》
CAS
2022年第2期262-266,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
颅脑损伤
逐步减压术
去骨瓣减压术
颅内压
回顾性分析
生活质量
对照研究
短中期并发症
Severe head injury
Gradual decompression
Decompressive craniectomy
Intracranial pressure
Retrospective analysis
Quality of life
Controlled study
Short-and mid-term complications
