摘要
目的：重型颅脑损伤脑疝去骨瓣减压的手术指征及预后因素研究。方法：收集2013-12-2015-11在我院住院治疗的重型颅脑外伤合并脑疝的患者65例,分析患者行去骨瓣减压术的手术指征,利用单因素和多因素Logistic回归分析影响患者预后的危险因素。结果：65例患者中47例（72.31%）行去瓣膜减压术,18例（27.69%）患者保留骨瓣;其中双侧瞳孔散大的患者19例（29.23%）、GCS评分≤6分的患者40例（61.54%）、硬膜下血肿的患者36例（55.38%）行去瓣膜减压术的比例较高,且差异均有统计学意义（P30mmHg持续30min的重型颅脑损伤患者,以及进行性意识障碍的急性颅脑创伤患者,CT显示脑挫裂伤、出血、脑水肿等占位效应明显（中线移位、基底池受压）、经渗透脱水利尿药物等一线治疗方案颅高压无法控制的患者是去骨瓣减压的手术指征。其中双侧瞳孔散大、GCS评分≤6分、硬膜下血肿的重型颅脑损伤脑疝患者行去瓣膜减压术的比例较高,合并伤、双侧瞳孔散大、GCS评分≤6分、术前CT基底池形态异常是影响患者发生不良预后的主要危险因素。
Objective：To study surgical indications and prognostic factors of decompressive craniectomy for severe craniocerebral injury with cerebral hernia.Method：Sixty-five cases of severe craniocerebral trauma with cerebral hernia were collected from December 2013 to November 2015.Indications for decompressive craniectomy were analyzed.Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of prognosis.Result：Among 65 patients,47cases（72.31%）underwent decompressive craniectomy,and 18 of them were（27.69%）retained bone flap.Patients with mydriasis（19cases,29.23%）,GCS≤6（40cases,61.54%）,subdural hematoma（36cases,55.38%）had a higher proportion of decompression craniectomy than those without above features（P〈0.05）.29cases（44.62%）had poor prognosis（GOS grade Ⅰ- Ⅱ）,and 36cases（55.38%）had good prognosis（GOS gradeⅢ-Ⅵ）.Multivariate Logistic regression analysis showed that combined injury（OR=4.768,95%CI=2.769-8.127）,mydriasis（OR=2.632,95%CI=1.625-6.545）,GCS ≤6（OR=3.545,95%CI=2.230-10.714）,paramorphia of basilar cistern scanned by preoperative CT（OR=2.771,95%CI=1.698-12.532）were major risk factors of poor prognosis（P〈0.05）.Conclusion：Intended population of decompressive craniectomy are patients of severe craniocerebral injury with mydriasis and cerebral hernia,with brain contusion,laceration,hemorrhage,cerebral edema and other related mass effects（midline shift,basal cisterns）showed by CT,progressly increased ICP（〉30mmHg lastingfor 30minutes）,with conscious disturbance,or with uncontrlled intracranial hypertention after first-line treatment like diuretics.Patients of severe craniocerebral injury with cerebral hernia and mydriasis,GCS ≤6and subdural hematoma have higher possibility of receiving decompression craniectomy.Combined injury,GCS score≤6,preoperative CT basal pool shape anomaly was the main risk factors of poor prognosis.
出处
《临床急诊杂志》
CAS
2016年第9期675-678,681,共5页
Journal of Clinical Emergency
关键词
重型颅脑损伤
脑疝
去骨瓣减压术
手术指征
预后因素
severe craniocerebral injury
cerebral hernia
decompression craniectomy
surgical indications
prognostic factors
