标准去骨瓣减压术联合脑脊液循环重建治疗重型颅脑损伤的疗效比较

摘要

Objective To compare the effects of standard decompressive craniectomy (DC) vs.combined cisternostomy on severe traumatic brain injury (STBI).Methods Seventy-two patients with severe brain injury were divided into standard decompressive craniectomy group (control group,n=34) and DC combined cisternostomy group (treatment group,n=38).The clinical parameters from pre-and post-surgery were compared between the two groups.Results There was no statistical difference in clinical data including gander,age,injury causes,GSC score,Helsinki CT score and operative opportunity between two groups before surgery (P＞0.05).The treatment group was inferior in the duration of decompression (2.8±0.4 h vs.2.5±0.3 h,P＜0.05) relative to control treatment group.However,treatment group were superior to control group in the mean time of admission in neuro-intensive care unit (5.54±3.09 d vs.7.24±2.74 d,P＜0.01),the cumulative time of intracranial pressure (ICP) more than 20 nmHg within seven days after surgery(23.2±4.4 h vs.56.8±8.3 h,P＜0.01),Helsinki CT scores at postoperative day (3(2,5) vs.5(2,9),P＜ 0.01)and Glasgow Outcome Scores (GOS) at 3 month after surgery (P＜0.01).Conclusion DC combined with cisternostomy for STBI is significantly better than standard decompressive craniectomy,which is worth further study by multicenter clinical trials.%目的 探讨单纯标准去骨瓣减压术与联合脑脊液循环重建术治疗重型颅脑损伤的疗效.方法 72例经同一术者手术的重型颅脑损伤患者分为研究组38例和对照组34例.研究组给予标准去骨瓣减压术联合脑脊液循环重建治疗,对照组予以单纯去骨瓣治疗.对比两组临床疗效.结果 研究组与对照组术前临床资料(性别、年龄、致伤原因、GCS评分、Helsinki CT评分及手术时机)无明显差异(P＞0.05).研究组手术减压完成时间相对较长(2.8±0.4 hvs.2.5±0.3 h,P＜0.05);、术后第1天Helsinki CT评分较低[3(2,5)vs.5(2,9),P＜0.01];术后NICU滞留时间较短(5.54±3.09 d vs.7.24±2.74 d,P＜0.01);术后7d内颅内压超过20 mmHg的累计时间较短(23.2±4.4 h vs 56.8±8.3 h,P＜0.01);术后3个月GOS评分研究组显著优于对照组,差异有统计学意义(P＜0.01).结论 相对于传统标准去骨瓣减压术,联合术中脑脊液循环重建治疗重型颅脑损伤的疗效显著提高,值得多中心临床研究进一步研究.