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目的探讨重度颅脑损伤继发急性硬脑下血肿患者应用标准大骨瓣开颅手术治疗的临床效果以及安全性。方法选取2014年1月—2016年1月重度颅脑损伤继发急性硬膜下血肿患者60例,随机分为常规组和观察组,各30例,常规组患者实施常规骨瓣开颅手术治疗,观察组患者实施标准大骨瓣开颅手术治疗,对比两组患者术前以及术后不同时间点的血肿量、临床治疗效果,以及随访过程中患者术后并发症的发生情况。结果观察组术后1d、3d、7d血肿量分别低于常规组;观察组治疗有效率(66.7%)优于常规组;观察组病死率(3.3%)明显低于常规组;脑梗死发生率两组患者对比差异无统计学意义(P>0.05),颅内感染、硬脑膜下积液、迟发性血肿、切口脑脊液漏、急性脑膨出发生率均低于常规组,对比差异有统计学意义(P<0.05)。结论标准大骨瓣开颅手术治疗重度颅脑损伤继发急性硬脑膜下血肿安全性高,临床效果显著,值得临床推广。
Objective To investigate the clinical effect and safety of standard craniotomy for severe craniocerebral injury in patients with acute subdural hematoma. Methods Sixty patients with acute subdural hematoma secondary to severe craniocerebral injury were selected from January 2014 to January 2016, and were randomly divided into routine group and observation group, with 30 cases in each group. Conventional bone flap craniotomy . The patients in the observation group were treated with standard craniotomy. The hematoma volume, clinical effect and the incidence of postoperative complications during the follow-up were compared between the two groups before and after surgery. Results The hematoma volume of the observation group was significantly lower than that of the conventional one on the 1st, 3rd, and 7th day after operation. The effective rate of the observation group was higher than that of the control group (66.7%). The mortality of the observation group (3.3%) was significantly lower than that of the conventional group There was no significant difference between the two groups (P> 0.05). The incidence of intracranial infection, subdural effusion, delayed hematoma, cerebrospinal fluid leakage and acute encephalocele incision were lower than those in the conventional group Significance (P <0.05). Conclusions Standard large craniotomy for the treatment of severe acute traumatic brain injury with acute subdural hematoma high safety, clinical effect is significant, worthy of clinical promotion.