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目的 探讨不同术式对于重型颅脑创伤患者顽固性高颅压的术后疗效,并就手术时机以及预后情况进行分析.方法 选择2011年1月-2016年1月期间苏州市第七人民医院收治的84例重型颅脑创伤后出现顽固性高颅压患者,根据患者手术的方式分为两组,其中对照组42例采用传统骨瓣开颅减压术,而观察组42例则是采用大骨瓣开颅减压术,对比两组患者的手术疗效、美国神经功能缺损(NIH stroke scale,NIHSS)评分以及相关并发症的发生率.结果 两组患者术后常规随访3个月,其中对照组恢复良好率为42.86%(18/42),而观察组恢复良好率是69.05%(29/42),差异有统计学意义(P<0.05);两组患者治疗后NIHSS评分均较治疗前有所改善,而以观察组患者的改善程度更具有优势,差异有统计学意义(P<0.05);术后并发症主要为血肿、脑切口疝等,对照组总并发症发生率47.62%(20/42),而观察组总并发症发生率为16.67%(7/42),两组差异有统计学意义(P<0.05).结论 对于重型颅脑创伤后出现顽固性高颅压的患者,可以采用大骨瓣开颅减压术来降低颅内压,手术疗效明显优于传统的开颅术,同时NIHSS评分改善更佳,降低了并发症发生率,值得临床推广.“,”Objective To explore the clinical effect of different therapies in severe traumatic brain injury patients complicated with intractable increased cranial pressure and analyze its operation timing and prognosis. Method 84 severe traumatic brain injury patients complicated with intractable increased cranial pressure treated from January 2011 to January 2016 in our hospital were selected. The subjects were divided into two groups according to the different therapies, 42 cases in each group. The control group adopted the conventional decompression craniotomy;the observation group adopted the large trauma craniotomy. The clinical effect, NIHSS points and incidence rate of complications for two groups was compared. Results After 3m of follow-up visit, the good rate for control group (42.86%,18/42) was lower than observation group (69.05%,29/42) (P<0.05); after surgery, the NIHSS points for observation group were even better than control group (P<0.05); the major complications included hematoma, incisional hernia, etc. The incidence rate of complications for control group (47.62%,20/42) was higher than observation group (16.67%,7/42) (P<0.05).Conclusion For severe traumatic brain injury patients complicated with intractable increased cranial pressure, the large trauma craniotomy can reduce the cranial pressure, enhance the clinical effects, improve the NIHSS points and reduce the incidence rate of complications, worthy of clinical promotion.