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目的比较标准大骨瓣减压术与常规骨瓣开颅术治疗重型颅脑损伤的临床效果。方法选取灵山县中医医院2014年8月—2016年8月收治的重型颅脑损伤患者124例,按照随机排列表法将患者分为常规组与标准组,各62例。常规组患者采用常规骨瓣开颅术治疗,标准组患者采用标准大骨瓣减压术治疗,比较两组患者治疗效果、神经功能[格拉斯哥(GCS)评分及神经功能缺损(NIHSS)评分]、颅内压水平、血清炎性标志物[白介素2(IL-2)、白介素4(IL-4)及肿瘤坏死因子α(TNF-α)]及并发症发生情况。结果标准组治疗效果优于常规组(P<0.05)。术前两组患者GCS评分、NIHSS评分及颅内压水平比较,差异无统计学意义(P>0.05);术后标准组GCS评分高于常规组,NIHSS评分及颅内压水平低于常规组(P<0.05)。术前两组患者IL-2、IL-4及TNF-α水平比较,差异无统计学意义(P>0.05);术后标准组IL-2、TNF-α水平低于常规组,IL-4高于常规组(P<0.05)。标准组并发症发生率为3.23%,低于常规组的21.43%(P<0.05)。结论与常规骨瓣开颅术治疗相比,标准大骨瓣减压术治疗重型颅脑损伤患者的临床效果更佳,在改善患者术后神经功能,降低炎性反应,安全性方面更具优势。
Objective To compare the clinical effects of standard decompressive craniectomy with conventional craniotomy for the treatment of severe craniocerebral injury. Methods Totally 124 patients with severe craniocerebral injury admitted from August 2014 to August 2016 in Lingshan Traditional Chinese Medicine Hospital were randomly divided into routine group and standard group, with 62 cases in each group. The patients in the conventional group were treated with open craniotomy. The standard patients were treated with standard decompressive craniectomy. The treatment effect, neurological function (Glasgow score and NIHSS score) were compared between the two groups. Intracranial pressure, serum inflammatory markers IL-2, IL-4 and tumor necrosis factor-α (TNF-α) and the incidence of complications. Results The standard treatment group was better than the conventional group (P <0.05). There was no significant difference in GCS score, NIHSS score and intracranial pressure between the two groups before operation (P> 0.05). GCS score of the standard group was higher than that of the conventional group, NIHSS score and intracranial pressure were lower than those of the conventional group (P <0.05). The levels of IL-2, IL-4 and TNF-α in the two groups before operation were not significantly different (P> 0.05). The levels of IL-2 and TNF- Higher than the conventional group (P <0.05). The complication rate of the standard group was 3.23%, which was lower than 21.43% of the conventional group (P <0.05). Conclusion Compared with the conventional craniotomy, the treatment of severe craniocerebral injury by standard decompressive craniectomy is more effective in improving the neurological function, reducing the inflammatory reaction and the safety of patients .