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目的探讨实行标准大骨瓣开颅手术治疗重型颅脑损伤的手术效果。方法笔者对34例重型脑挫裂伤的患者(具备手术指征)均在入院后半小时内采用标准大骨瓣开颅手术,并于术后3个月对生存者进行格拉斯哥预后评分(GOS)。结果病死率6%,中残以上康复率85%。结论重型脑挫裂伤的患者采用标准大骨瓣开颅手术,该方法具有骨窗范围大,使挫伤的大脑半球充分显露,有利于清除颅内血肿,使损伤的大脑半球及侧裂血管充分减压,有利于静脉回流,有效降低颅内压,减少脑梗死和闭塞率,减少脑组织嵌顿的机会,有利于脑疝恢复等优点,如果在实际工作中能掌握好手术适应症,把握好手术时机及操作规范,不但可以挽救大部分患者的生命,而且能减少脑神经损伤,尽可能保留脑功能,可以使多数存活患者获得较好的生存质量。
Objective To investigate the effect of standard craniotomy on severe craniocerebral injury. Methods The author of 34 cases of severe contusion and laceration of the patients (with surgical indications) were within half an hour after admission standard large craniotomy craniotomy, and 3 months after surgery for survivors Glasgow Prognosis Score (GOS ). Results The case fatality rate was 6% and the recovery rate was 85%. Conclusions The patients with severe cerebral contusion and laceration were treated by standard large craniotomy. The method has the advantages of large bone window area, sufficient exposure of contusive cerebral hemispheres, removal of intracranial hematoma, full damage of the cerebral hemispheres and fissure blood vessels Decompression, is conducive to venous return, effectively reduce intracranial pressure, reduce cerebral infarction and occlusion rate, reduce the chance of incarcerated brain tissue is conducive to the recovery of hernia, etc., if the actual work can grasp the indications for surgery, grasp Good timing and operation of the operation, not only can save the lives of most patients, but also reduce brain damage, as much as possible to retain brain function, can make the majority of survivors get better quality of life.