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目的 :研究紧急钻颅和顺序脑膜剪开术在特重型颅脑损伤合并脑疝患者中的临床治疗效果。方法 :30例特重型颅脑损伤合并脑疝患者接受紧急钻颅+顺序脑膜剪开术治疗(治疗组),并将同期27例接受标准大骨瓣减压术+一次性脑膜剪开术治疗的同病症患者作为对照(对照组),分析两组确诊至减颅内压完成时间、术中急性脑膨出、瞳孔恢复情况和术后6月预后情况。结果 :治疗组确诊至减颅内压完成时间、术中急性脑膨出率显著低于对照组;治疗组瞳孔恢复正常率40%,部分缩小率53.33%,无变化率6.67%,而对照组则分别为14.81%,25.93%和59.26%,两组差异显著;术后6月GOS评分显示,治疗组良好率53.33%,中残率20%,重残率10%,植物生存率3.33%,死亡率13.34%,而对照组则分别为11.11%,14.81%,18.52%,7.41%和48.15%,两组差异显著;治疗组术后6月并发症总发生率30%,对照组81.48%,两组差异显著。结论 :紧急钻颅和顺序脑硬膜剪开术可为特重型颅脑损伤合并脑疝患者赢得充分减压时间,显著提高抢救成功率,疗效显著,有效降低术后残疾率和死亡率,减少并发症发生。
Objective: To study the clinical effect of emergency craniocerebral and sequential meningeal dissection in patients with severe craniocerebral injury complicated with cerebral hernia. Methods: Thirty patients with severe traumatic brain injury complicated with hernia were treated with emergency drilling and sequential meninctomy (treatment group), and 27 patients undergoing standard decompressive craniectomy combined with one-time meningeal dissection Of patients with the same disease as a control (control group), analysis of the two groups were confirmed to reduce the time to complete intracranial pressure, intraoperative acute encephalocele, pupil recovery and postoperative prognosis in June. Results: The treatment group was diagnosed to reduce the completion time of intracranial pressure, acute intracerebral prolapse rate was significantly lower than the control group; the treatment group pupil recovery rate was 40%, partial reduction rate of 53.33%, no change rate of 6.67%, while the control group Respectively. The GOS score at 6 months after operation showed that the good rate was 53.33% in the treatment group, 20% in the disabled group, 10% in the severe disability group, 3.33% in the plant survival rate, The mortality rate was 13.34% in the control group, while it was 11.11%, 14.81%, 18.52%, 7.41% and 48.15% respectively in the control group, with significant difference between the two groups. The total complication rate was 30% in the treatment group and 81.48% Significant difference between the two groups. Conclusions: Emergency drilling and sequential brain dura mater scissors can obtain sufficient decompression time for patients with severe craniocerebral injury and cerebral hernia, significantly improve the success rate of salvage, and have a significant curative effect, effectively reduce postoperative morbidity and mortality, and reduce Complications occur.