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目的:探讨在单侧或以单侧为主的重型颅脑损伤病例中,何种手术方式更适宜处理手术中出现的急性脑膨出。方法:对我科自2008年5月至2010年12月收治的以单侧为主的重型颅脑损伤且术中出现急性脑膨出的52例临床资料进行回顾性分析,研究单、双侧去骨瓣减压术对患者颅内压(ICP)及伤后6个月时的GOS评分的影响。结果:单侧去骨瓣减压患者29例,分为恢复良好组(GOS 4-5分,n=6),不良组(GOS 2-3分,n=9)和死亡组(GOS 1分,n=14);双侧去骨瓣减压患者23例亦分为恢复良好组(n=6),不良组(n=12)和死亡组(n=5);两种减压术的死亡率差异显著(P<0.05)。单侧和双侧去骨瓣减压术均明显降低ICP(P<0.05),但双侧减压的存活组其术后ICP(17.2±4.2 mmHg)显著低于单侧减压的存活组(25.0±5.4 mmHg)(P<0.05)。结论:对以单侧为主的重型颅脑损伤,同次行双侧去骨瓣减压术较单侧减压更能有效降低术中急性脑膨出所致高颅压,降低死亡率。
OBJECTIVE: To investigate whether the surgical method is more suitable for the treatment of acute encephalocele during operation in cases of unilateral or unilateral severe head injury. Methods: A retrospective analysis was performed on 52 cases of acute brain bulge in our department from May 2008 to December 2010 with unilateral severe head injury and acute encephalocele during operation. Effects of decompressive craniectomy on intracranial pressure (ICP) and GOS score at 6 months after injury. Results: A total of 29 patients with unilateral decompressive craniectomy were divided into three groups: the recovery group (GOS 4-5, n = 6), the poor group (GOS 2-3, n = 9) and the death group , n = 14). Bilateral decompressive craniectomy was also performed in 23 patients with well-recovered group (n = 6), poor group (n = 12) and death group The difference of mortality was significant (P <0.05). Both unilateral and bilateral decompressive craniectomy significantly reduced the ICP (P <0.05), but the postoperative ICP (17.2 ± 4.2 mmHg) in the bilateral decompression group was significantly lower than that in the unilateral decompression group 25.0 ± 5.4 mmHg) (P <0.05). Conclusion: For unilateral severe craniocerebral injury, the same bilateral decompressive craniectomy is more effective than unilateral decompression in reducing intracranial acute intracerebral pressure caused by intracranial hypertension and reduce mortality.