脑池造瘘术对创伤性脑损伤患者预后的影响

摘要

目的 探讨脑池造瘘术对创伤性脑损伤(TBI)患者预后的影响.方法 采用回顾性病例对照研究分析2017年5月-2018年9月山西大医院收治的46例TBI患者临床资料,其中男37例,女9例;年龄24～80岁[(49.8±15.7)岁].损伤严重度评分(ISS)6～42分[(25.0±8.2)分],格拉斯哥昏迷评分(GCS)3 ～ 14分[(3.4±1.7)分].23例仅行常规手术(对照组),23例在常规手术基础上加做脑池造瘘术(造瘘组).两组患者术前均行有创颅内压监测.比较两组患者术毕颅内压、术后1周颅内压、术后机械通气时间、神经外科ICU(NICU)时间、术后脱水药用量、去骨瓣减压率、术后感染率、病死率、住院时间、出院时GCS及随访3个月的格拉斯哥预后评分(GOS).结果 造瘘组术毕颅内压[(7.1±5.7)mmHg∶(14.2±12.0)mmHg]、术后1周颅内压[(11.8±0.5)mmHg∶(14.0±0.7) mmHg]、术后脱水药用量[0(0～500.0)ml∶1 275(787.5 ～3 812.5)ml]及去骨瓣减压率(57％∶91％)均低于对照组(P＜0.05).造瘘组术后机械通气时间[120(42.0 ～225.0)h∶89 (65.5～203.5)h]、NICU时间[236(182.0 ～ 340.5)h∶281(114.0 ～400.0)h]、术后感染率(4％∶0)、病死率(13％∶39％)及住院时间[32(20.0 ～44.5)h∶25(12.0 ～30.5)h]与对照组比较差异均无统计学意义(P＞0.05).造瘘组出院GCS[(10.7±4.2)分∶(7.9±4.2)分]高于对照组.随访3个月GOS造瘘组预后良好18例,优于对照组的11例(P＜0.05).结论 对于TBI患者,脑池造瘘术与常规手术相比,可降低颅内压,减少脱水药用量和去骨瓣减压率,从而改善患者的预后.%Objective To investigate the effect of cisternostomy on the prognosis of patients with traumatic brain injury (TBI).Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with TBI admitted to Shanxi Dayi Hospital from May 2017 to September 2018.There were 37 males and nine females,aged 24-80 years [(49.8 ± 15.7)years].The injury severity score (ISS) was 6-42 points [(25.0 ± 8.2)points],and the Glasgow Coma score (GCS) was 3-14 points [(3.4 ± 1.7) points].Twenty-three patients underwent routine surgery only (control group),and 23 patients underwent cisternostomy (cisternostomy group) on the basis of routine surgery.Intracranial pressure monitoring was performed in both groups before surgery.The postoperative intracranial pressure,intracranial pressure 1 week after operation,postoperative mechanical ventilation time,neurosurgical ICU (NICU) time,postoperative dehydration dose,decompressive craniectomy rate,postoperative infection rate,mortality rate,length of hospital stay,GCS at discharge,and Glasgow outcome score (GOS) of 3 months of follow-up were compared between the two groups.Results Compared with the control group,the cistemostomy group had lower postoperative intracranial pressure [(7.1 ± 5.7) mmHg vs.(14.2 ± 12.0) mmHg)],intracranial pressure 1 week after operation [(11.8 ± 0.5) mmHg vs.(14.0 ± 0.7) mmHg],postoperative dosage of dehydrating agent [0 (0-500.0) ml vs.1 275 (787.5-3 812.5) ml] and decompression rate (57％ ∶ 91％) (P ＜ 0.05).There were no significant differences between the cistemostomy group and control group in postoperative mechanical ventilation time [120 (42.0-225.0)hours vs.89(65.5-203.5)hours],NICU time [236(182.0-340.5)hoursvs.281 (114-400)hours],postoperative infection rate (4％ vs.0),mortality rate (13％ vs.39％) and hospital stay [32 (20.0-44.5) hours vs.25 (12.0-30.5)hours] (P ＞ 0.05).The cisternostomy group had higher GCS score at discharge than the control group [(10.7 ± 4.2) points vs.(7.9 ± 4.2) points] (P ＜ 0.05).After 3 months of follow-up,18 patients in the cisternostomy group showed good prognosis,better than that in the control group (11 patients) (P ＜ 0.05).Conclusion For TBI patients,cisternostomy can clear the blood cerebrospinal fluid,reduce harmful metabolic products in the brain,reduce intracranial pressure and hence improve the prognosis of patients.