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目的分析早期去骨瓣压术治疗重型脑伤38例治疗体会。方法选取2013年4月至2016年4月期间在我院就诊的重型脑伤患者38例,随机分为试验组(采用早期去骨瓣压术治疗)和对照组(采用大骨瓣减压术治疗),各19例,分析两组患者的临床疗效,术前和术后第1、4、8天颅内压变化,术后随访(5个月)的格拉斯哥昏迷评分(GOS)评分和Barthel指数(BAI)评分,以及术后并发症情况,采用SPSS20.0统计学软件进行分析。结果(1)试验组中的死亡、植物生存、重残和中度残疾的病例数都低于对照组,良好的病例数高于对照组,两组之间的比较有统计学差异(P<0.05)。(2)随着时间的延长,两组患者术后的颅内压呈现逐渐降低的趋势,且术后1d、4d、8d和术前相互之间的颅内压比较有统计学差异(P<0.05);试验组术后1d的颅内压低于对照组(23.94±4.79 VS31.77±5.63),试验组术后4d的颅内压低于对照组(20.75±4.48 VS 28.73±4.93),试验组术后8d的颅内压低于对照组(17.29±3.84 VS 23.67±4.46),两组之间比较有统计学差异(P<0.05)。(3)试验组的GOS评分高于对照组(17.95±3.63 VS 10.12±3.96),试验组的BAI评分高于对照组(5.34±2.28 VS 3.93±2.14),两组之间比较有统计学差异(P<0.05)。(4)试验组中的脑脊液漏、外伤性脑梗死、外伤性癫痫、脑积水和伤口感病例数都低于对照组,两组之间比较有统计学差异(P<0.05)。结论早期去骨瓣压术治疗重型脑伤,提高了临床疗效,降低了颅内压,改善了患者术后的生存质量,减少了并发症的发生。
Objective To analyze the treatment of 38 patients with severe brain injury treated by early craniotomy. Methods Thirty-eight patients with severe traumatic brain injury in our hospital from April 2013 to April 2016 were randomly divided into experimental group (treated with early craniotomy) and control group (treated with decompressive craniectomy) ) And 19 cases in each group. The clinical curative effect, preoperative and postoperative 1st, 4th, 8th day intracranial pressure changes, postoperative follow-up (5 months) GOS score and Barthel index (BAI) score, and postoperative complications, using SPSS20.0 statistical software for analysis. Results (1) The number of cases of death, plant survival, severe disability and moderate disability in the experimental group were lower than that of the control group, the number of good cases was higher than that of the control group, the difference between the two groups was statistically significant (P < 0.05). (2) With the extension of time, the intracranial pressure gradually decreased after operation in both groups, and the intracranial pressure was significantly different between the two groups at postoperative 1d, 4d, 8d and before operation (P < 0.05). The intracranial pressure of the experimental group was significantly lower than that of the control group (23.94 ± 4.79 vs 31.77 ± 5.63) at 1 day after operation. The intracranial pressure of the experimental group 4 days after operation was significantly lower than that of the control group (20.75 ± 4.48 vs 28.73 ± 4.93) The intracranial pressure at 8 days after operation was significantly lower than that of the control group (17.29 ± 3.84 VS 23.67 ± 4.46). There was significant difference between the two groups (P <0.05). (3) The GOS score of the experimental group was higher than that of the control group (17.95 ± 3.63 vs 10.12 ± 3.96), and the BAI score of the experimental group was higher than that of the control group (5.34 ± 2.28 vs 3.93 ± 2.14). There was significant difference between the two groups (P <0.05). (4) The number of cerebrospinal fluid leakage, traumatic cerebral infarction, traumatic epilepsy, hydrocephalus and wound infection in the experimental group were lower than those in the control group, with statistical significance (P <0.05). Conclusions Early treatment of severe traumatic brain injury with craniectomy can improve clinical curative effect, reduce intracranial pressure, improve the quality of life after operation and reduce the incidence of complications.